title: Prediction of poorer prognosis by infection with antibiotic-resistant gram-positive cocci than by infection with antibiotic-sensitive strains.
abstract: OBJECTIVE
  Surgical patients with antibiotic-resistant gram-positive coccal (GPC) infections have a poorer prognosis than those with antibiotic-sensitive GPC infections, and colonization with resistant GPC predisposes to the development of resistant GPC infections.
  
  
  METHODS
  All infections among surgical patients from December 1, 1996, to December 1, 1998, were followed up prospectively. Patients with antibiotic-sensitive and antibiotic-resistant GPC infections were compared. Cohorts were also subdivided on the basis of GPC species, colonization status, and immunosuppression.
  
  
  METHODS
  The surgical wards and intensive care units of a tertiary care, university hospital.
  
  
  METHODS
  In-hospital mortality, inhospital mortality during antibiotic therapy, length of stay, and length of stay from the time of initiation of antibiotics to discharge.
  
  
  RESULTS
  Antibiotic-resistant GPC infection compared ki4th antibiotic-sensitive GPC infection was associated with a higher mortality and previous colonization rate (25.8% and 31.0% vs 17.6% and 8.8%, respectively; P = .04 and P<.001, respectively) and a markedly longer length of stay (55.0 +/- 3.3 vs 31.0 +/- 2.0 days; P<.001). Length of stay and treatment to discharge times were longer after resistant Staphylococcus aureus infections than after resistant Staphylococcus epidermidis infections. The mortality and length of stay of patients with gentamicin-resistant or vancomycin-resistant enterococcal infections were equivalently higher than those with antibiotic-sensitive enterococcal infections. Transplant recipients with resistant enterococcal infection had the highest mortality (41.9%).
  
  
  CONCLUSIONS
  Surgical patients who develop antibiotic-resistant GPC infections have a significantly higher mortality rate, longer length of stay, and longer treatment to discharge time than patients with antibiotic-sensitive GPC infections. Colonization with resistant GPC predisposes to resistant GPC infection. Gentamicin-resistant enterococcus appears to be as virulent as vancomycin-resistant enterococcus.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville 22906-0005, USA. tgg2s@virginia.edu
authors.forename: T G
authors.initials: TG
authors.lastname: Gleason
authors.forename: T D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: S J
authors.initials: SJ
authors.lastname: Pelletier
authors.forename: D P
authors.initials: DP
authors.lastname: Raymond
authors.forename: T B
authors.initials: TB
authors.lastname: Karchmer
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: R G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000401:mortality*; D011379:Prognosis; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000401:mortality