title: Colonization by high-level aminoglycoside-resistant enterococci in intensive care unit patients: epidemiology and clinical relevance.
abstract: A cohort study was performed to investigate the risk factors for colonization with high-level aminoglycoside-resistant enterococci (HLARE) in intensive care unit (ICU) patients. Colonization was investigated by performing surveillance samples during ICU stay. Clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. Eighty-six patients with an ICU stay of >48 h were included; two were colonized with HLARE at admission, and 24 (28.5%) acquired HLARE during their stay in the ICU. HLARE were initially isolated from rectal swabs alone. Thirty-five percent of Enterococcus faecalis and 57% of E. faecium showed high-level resistance to gentamicin or streptomycin. Most isolates were clonally unrelated. Using multi-variate analysis, the only variable associated with HLARE colonization was previous antimicrobial use. Five patients had HLARE isolated from clinical samples, three of them with infection; in all of these, colonization with the same clone had been detected previously by surveillance samples. We conclude that most infections due to HLARE in the ICU are preceded by previous colonization, and that antimicrobial use is the main risk factor for colonization.
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, 3, 41071 Sevilla, Spain. jrb@nacom.es
authors.forename: J
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: E
authors.initials: E
authors.lastname: Ramírez
authors.forename: M A
authors.initials: MA
authors.lastname: Muniain
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.forename: P
authors.initials: P
authors.lastname: Joyanes
authors.forename: F
authors.initials: F
authors.lastname: González
authors.forename: M
authors.initials: M
authors.lastname: García-Sánchez
authors.forename: L
authors.initials: L
authors.lastname: Martínez-Martínez
mesh_terms: D000617:Aminoglycosides / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D013293:Enterococcus faecalis / Q000187:drug effects; D016984:Enterococcus faecium / Q000187:drug effects; D005260:Female; D005838:Genotype; D005839:Gentamicins / Q000494:pharmacology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D017720:Molecular Epidemiology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013307:Streptomycin / Q000494:pharmacology
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D005839:Gentamicins; D013307:Streptomycin