title: High-level gentamicin resistance in Enterococcus faecalis bacteremia.
abstract: In a retrospective analysis, patients with bacteremia due to Enterococcus faecalis with and without high-level gentamicin resistance (GRE; MIC greater than 2000 micrograms/ml) were compared. Bacteremic patients with GRE (n = 32) had significantly higher rates of nosocomial acquisition and bladder catheterization, longer hospitalizations, and more frequent prior treatment with cephalosporins than did bacteremic patients without high-level resistance (n = 19). Overall mortality was significantly associated with septic shock, high-risk source (intraabdominal, wound, respiratory tract, multiple, unknown), and polymicrobial bacteremia. Higher mortality was observed in GRE bacteremia (47%) than in bacteremia without high-level resistance (37%), but this difference was not statistically significant. For patients with monomicrobial bacteremia, low-risk source (genitourinary tract, intravascular), or treatment with antibiotics appropriate for the enterococcus, higher mortality with GRE bacteremia approached statistical significance. These results suggest that high-level resistance adversely affects survival with a pure E. faecalis bacteremia or low-risk bacteremic source. Also, response to antibiotic therapy may be diminished by high-level resistance.
authors.affiliation: Department of Medicine, (Division of Infectious Diseases), Northwestern University Medical School, Chicago, Illinois 60611.
authors.forename: G A
authors.initials: GA
authors.lastname: Noskin
authors.forename: M
authors.initials: M
authors.lastname: Till
authors.forename: B K
authors.initials: BK
authors.lastname: Patterson
authors.forename: J T
authors.initials: JT
authors.lastname: Clarke
authors.forename: J R
authors.initials: JR
authors.lastname: Warren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D002406:Catheterization, Peripheral; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D048909:Diabetes Complications; D004352:Drug Resistance, Microbial; D004697:Endocarditis, Bacterial / Q000209:etiology; D013293:Enterococcus faecalis / Q000187:drug effects*; D005839:Gentamicins / Q000494:pharmacology*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000150:complications; D012189:Retrospective Studies; D014546:Urinary Catheterization
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins