title: Epidemiology and clinical outcome of enterococcal bacteraemia in an acute care hospital.
abstract: OBJECTIVE
  To determine the epidemiology and clinical outcome of enterococcal bacteraemia in an acute care hospital.
  
  
  METHODS
  This is a retrospective study on enterococcal bacteraemia in an acute hospital from January 1999 to June 2001. Patients' clinical case notes were reviewed and their demographic, clinical and microbiological data were recorded.
  
  
  RESULTS
  A total of 42 patients (25 males and 17 females) were included in the study, their mean age was 74.8+/-10.9 years. The majority of them had underlying diabetes mellitus and neurological disease. Seventeen patients required intensive care. Sources of enterococcal bacteraemia were identified in 21 cases (urinary tract, 13 patients; hepatobiliary, five; cardiovascular, two and soft tissues, one patient). Eighteen patients had prior invasive procedures. All the Enterococcus species isolated were vancomycin-susceptible; however, eight were ampicillin-resistant and 13 had high-level gentamicin resistance. Shock, disseminated intravascular coagulopathy, acute renal failure and cardiorespiratory arrest occurred in 42% of the cases. Antibiotics were prescribed appropriately in 31 patients and seven deaths were recorded. Of the 11 patients who received inappropriate therapy, six deaths were recorded. Inappropriate antibiotic therapy was associated with mortality. The mortality rate was 31%. Only one patient had a relapse of enterococcal bacteraemia from urinary tract infection secondary to underlying ureteric stricture. There were no vancomycin resistant cases.
  
  
  CONCLUSIONS
  Urinary tract infection was the most common source of enterococcal bacteraemia. Appropriate antibiotics were essential in treating bacteraemia to reduce mortality. Vancomycin-resistant Enterococcus was not detected. The presence of comorbid conditions and invasive procedures in patients with enterococcal bacteraemia were found in 86 and 71% of patients, respectively.
authors.affiliation: Department of General Medicine, Changi General Hospital, 2, Simei Street 3, Singapore 529889, Singapore. pohchoohean@hotmail.com
authors.forename: C H
authors.initials: CH
authors.lastname: Poh
authors.forename: H M L
authors.initials: HM
authors.lastname: Oh
authors.forename: A L
authors.initials: AL
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents