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Comparison of patients with enterococcal bacteremia due to strains with and without high-level resistance to
1Department of Internal Medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio.
Abstract:
Patients with enterococcal bacteremia due to strains with and without high-level gentamicin resistance (HLGR; MIC, > 2,000 mg/L) were compared. Between 1986 and 1991, there were 178 episodes of enterococcal bacteremia: 47 and 131 episodes, respectively, due to enterococcal strains with and without HLGR. Sixty-two, 57, and 59 episodes, respectively, were in patients with transient bacteremia (a single positive blood culture), bacteremia (two or more positive blood cultures), and polymicrobial bacteremia. Nosocomial bacteremia accounted for 61.7% and 51.1% of episodes due to strains with and without HLGR, respectively. All isolates were strains of Enterococcus faecalis except for 13 strains of Enterococcus faecium, 4 of Enterococcus avium, and 3 of Enterococcus durans. Although the mortality was slightly higher among patients infected with strains with HLGR than among those infected with strains without HLGR (38.3% vs. 30.5%, respectively), there was no statistical difference. The mortality rate was adversely affected by old age (P < .01) and rapidly and ultimately fatal underlying conditions (P < .001). The addition of gentamicin to the treatment regimens had no effect on mortality.
Insights
High-level gentamicin resistance (HLGR) in enterococcal bacteremia did not significantly impact patient mortality. Factors like age and underlying conditions were more critical determinants of survival in these infections.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Bacteriology
Background:
- Enterococcal bacteremia is a significant nosocomial infection.
- High-level gentamicin resistance (HLGR) can complicate treatment options.
- Understanding the clinical impact of HLGR in enterococcal infections is crucial.
Purpose of the Study:
- To compare patient outcomes in enterococcal bacteremia based on the presence or absence of high-level gentamicin resistance (HLGR).
- To identify factors influencing mortality in patients with enterococcal bacteremia.
- To evaluate the efficacy of gentamicin in treatment regimens.
Main Methods:
- Retrospective analysis of 178 enterococcal bacteremia episodes between 1986 and 1991.
- Categorization of isolates based on HLGR status (MIC > 2,000 mg/L).
- Comparison of mortality rates and influencing factors between HLGR-positive and HLGR-negative groups.
Main Results:
- No statistically significant difference in mortality between patients with HLGR (38.3%) and without HLGR (30.5%) enterococcal bacteremia.
- Nosocomial bacteremia was prevalent in both groups (61.7% with HLGR, 51.1% without).
- Old age and fatal underlying conditions were significant predictors of mortality (P < .01 and P < .001, respectively).
- Gentamicin addition to treatment regimens showed no effect on mortality.
Conclusions:
- High-level gentamicin resistance in enterococcal bacteremia does not appear to be an independent predictor of mortality.
- Patient-specific factors, such as age and comorbidities, are more critical in determining outcomes.
- Current treatment strategies, including gentamicin, may not alter mortality in HLGR-associated enterococcal bacteremia.