Enterococcal bacteraemia: a prospective study of 125 episodes

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Enterococcal bacteraemia is a significant nosocomial infection.
• Enterococcus faecium is the predominant species causing these infections.
• Antimicrobial resistance is a growing concern in enterococcal infections.

Purpose of the Study:

• To prospectively analyze episodes of enterococcal bacteraemia.
• To identify common species, resistance patterns, and sources of infection.
• To determine factors influencing mortality in enterococcal bacteraemia.

Main Methods:

• Prospective study of 125 episodes of enterococcal bacteraemia over 50 months.
• Microbiological analysis of 127 isolates for species identification and antimicrobial susceptibility testing.
• Clinical data collection on patient characteristics, underlying illnesses, and treatment outcomes.

Main Results:

• Enterococcus faecium accounted for 59.8% of isolates.
• Ampicillin resistance was 33.1%, vancomycin resistance 0.8%, and high-level gentamicin resistance 4.3%.
• 70.4% of episodes were nosocomial, with central venous catheters (CVCs) as the commonest source.
• Overall mortality was 17.6%, with 8.0% directly attributable to infection.
• Increased mortality observed in ICU/neonatal unit patients and those with recent antimicrobial therapy.
• CVC-related infections were associated with reduced mortality.

Conclusions:

• Enterococcal bacteraemia is associated with high rates of underlying illness and mortality.
• Antimicrobial resistance, particularly to ampicillin, is prevalent.
• Appropriate and timely antibiotic selection is critical for patient survival.
• Central venous catheter-related infections may have a better prognosis than other sources.