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[Bacteremia due to vancomycin-resistant enterococci in neutropenic cancer patients]
A Marron1, J Carratalà, J Ayats
1Servicio de Enfermedades Infecciosas, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona.
Background:
The aim of this study was to determine the incidence, clinical characteristics and outcome of vancomycin-resistant enterococcal bacteremia.
Patients And Methods:
We included all cases of enterococcal bacteremia in neutropenic cancer patients documented between January 1986 and December 1995 in a 1,000-bed university hospital, where a prospective surveillance of all cases of bacteremia is regularly done. Molecular typing was performed on all vancomycin-resistant strains with the analysis of chromosomic DNA by macrorestriction.
Results:
Seventeen cases of enterococcal bacteremia were documented. Seven (41%) were caused by vancomycin-resistant strains (E. faecium 3 and E. gallinarum 4), six of which occurred in the last 5 years of the study period. The average age of patients was 43 years (18-69) and most of them had acute leukemia. Eighty percent of these patients had received vancomycin and/or cephalosporins within 2 weeks prior to bacteremia. Previous administration of antibiotics was more frequent in patients with bacteremia caused by vancomycin-resistant enterococci than in those with bacteremia caused by susceptible strains (86% vs 30%; p < 0.05). The mean number of previous antibiotics (2.4 vs 0.8; p < 0.05) as well as days of treatment (13.6 vs 4.3; p = 0.05) were also higher among patients with resistant enterococcal bacteremia. The overall mortality was 57%.
Conclusions:
This study shows the emergence of sporadic cases of bacteremia caused by vancomycin-resistant enterococci in neutropenic cancer patients in our area. This fact seems to be related with the previous administration of antibiotics and advice that a rational use of these agents is needed.