Clinical features, risk factors and outcomes of bacteremia due to enterococci with high-level gentamicin resistance: comparison with bacteremia due to enterococci without high-level gentamicin resistance.
High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.
Jang
Hee-Chang
HC
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Lee
Shinwon
S
Song
Kyoung-Ho
KH
Jeon
Jae Hyun
JH
Park
Wan Beom
WB
Park
Sang-Won
SW
Kim
Hong Bin
HB
Kim
Nam Joong
NJ
Kim
Eui-Chong
EC
Oh
Myoung-Don
MD
Choe
Kang Won
KW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D002511:Cephalosporins / Q000494:pharmacology; D003428:Cross Infection / Q000150:complications; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D005839:Gentamicins / Q000494:pharmacology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000150:complications / Q000401:mortality; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D005839:Gentamicins