title: Comparison of patients with enterococcal bacteremia due to strains with and without high-level resistance to gentamicin.
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.
authors.affiliation: Department of Internal Medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio.
authors.forename: C
authors.initials: C
authors.lastname: Watanakunakorn
authors.forename: R
authors.initials: R
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D005839:Gentamicins