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Infections by ampicillin-resistant enterococci: a case-control study
M Venditti1, C Fimiani, P Baiocchi
1Servizio Aggregato di Consulenze Infettivologiche, Università La Sapienza Roma, Italy.
Abstract:
We identified 17 (20%) of 83 consecutive enterococcal isolates from hospitalized patients with documented infection as high-level ampicillin-resistant enterococci (ARE). Of these, 16 isolates were identified as Enterococcus faecium and 1 isolate as Enterococcus raffinosus. A case-control study found no significant differences with respect to underlying diseases, central venous catheterization, nosocomial acquisition of the infection and sites of infection. Patients with ARE infection were older and had a higher inhospital fatality rate than those with ampicillin-susceptible Enterococcus (ASE) infection. Hospitalization in a surgery service (usually for an abdominal procedure), prolonged hospital stay, prior treatment with antibiotics (in particular imipenem and metronidazole), were also more frequent among patients with ARE infection. ARE isolates were more frequently resistant to imipenem, ciprofloxacin and streptomycin than ASE isolates.
Insights
High-level ampicillin-resistant Enterococci (ARE) infections occurred in 20% of hospitalized patients. ARE infections were linked to older patients, longer hospital stays, and prior antibiotic use.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Enterococcal infections are a significant cause of hospital-acquired infections.
- High-level ampicillin resistance (ARE) in Enterococcus is a growing concern.
- Understanding risk factors for ARE is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of high-level ampicillin-resistant Enterococci (ARE) in hospitalized patients.
- To identify clinical factors associated with ARE infections compared to ampicillin-susceptible Enterococcus (ASE) infections.
Main Methods:
- Retrospective case-control study design.
- Analysis of 83 consecutive enterococcal isolates from patients with documented infections.
- Comparison of patient demographics, clinical characteristics, and antibiotic resistance profiles.
Main Results:
- 17% of enterococcal isolates were identified as ARE, primarily Enterococcus faecium.
- ARE infections were associated with older patient age and higher in-hospital fatality rates.
- Prior antibiotic treatment (imipenem, metronidazole) and prolonged hospitalization were more frequent in ARE cases.
- ARE isolates showed higher resistance rates to imipenem, ciprofloxacin, and streptomycin.
Conclusions:
- High-level ampicillin resistance is prevalent in hospital-acquired enterococcal infections.
- ARE infections are associated with increased patient morbidity and mortality.
- Antibiotic resistance patterns highlight the need for judicious antibiotic use and infection control strategies.