Glycopeptide resistance among coagulase-negative staphylococci that cause bacteremia: epidemiological and clinical findings from a case-control study.
A 1-year prospective case-control study (ratio of control patients to case patients, 3:1) was performed to assess the incidence, risk factors, and genotypic patterns of bacteremia caused by glycopeptide-resistant coagulase-negative staphylococci (CoNS) and their correlation with hospital glycopeptide use. Among 535 subjects with CoNS bacteremia, 20 subjects had a glycopeptide-resistant strain (19 strains were resistant to teicoplanin and 1 was resistant to both teicoplanin and vancomycin). The percentage of resistant isolates recovered in 1 year was 8% in intensive care units and 3% and 2% in medical and surgical wards, respectively. Genotypic analysis of resistant strains showed different patterns with a high degree of polymorphism. Use of glycopeptides in individual wards was not statistically associated with the percentage of resistance. Previous exposure to beta-lactams and glycopeptides, multiple hospitalization in the previous year, and concomitant pneumonia were significantly associated with the onset of glycopeptide-resistant CoNS bacteremia. Mortality rates were 25% among case patients and 18% among control patients, and they were significantly higher among patients who presented with concomitant pneumonia and a high Acute Physiology and Chronic Health Evaluation III score.
Tacconelli
E
E
Department of Infectious, Catholic University, Rome, Italy. etacconelli@rm.unicatt.it
Tumbarello
M
M
Donati
K G
KG
Bettio
M
M
Spanu
T
T
Leone
F
F
Sechi
L A
LA
Zanetti
S
S
Fadda
G
G
Cauda
R
R
D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D003030:Coagulase / Q000378:metabolism*; D024901:Drug Resistance, Multiple, Bacterial; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D017334:Teicoplanin / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D003030:Coagulase; D017334:Teicoplanin