Clinical features of enterococcal bacteremia due to ampicillin-susceptible and ampicillin-resistant enterococci: An eight-year retrospective comparison study.
Enterococcus consists human bowel flora, but sometimes behave as an important nosocomial pathogen. In order to identify clinical characteristics that help discriminate between ampicillin-susceptible and ampicillin-resistant enterococcal bacteremia in advance for antimicrobial susceptibility testing, a retrospective eight-year study was carried out in patients with enterococcal bacteremia experienced in Saga University Hospital, Japan. A total of 143 patients were included in the analysis: 85 (59.4%) with bacteremia caused by ampicillin-susceptible enterococci and 58 (40.6%) by ampicillin-resistant strains. Hospital-acquired bacteremia was present in 79.0% (113/143) of patients. Abdominal infections, urinary tract infections, and unknown source were predominant foci for the two groups. Patients with ampicillin-resistant enterococcal bacteremia was significantly associated with hematological cancer, immunosuppressive therapy, prior use of antibiotics, and mucositis associated with febrile neutropenia. The 28-day mortality was significantly higher in ampicillin-resistant enterococcal bacteremia. On multivariate analysis, independent risk factors for ampicillin-resistant enterococci were as follows: prior exposures to penicillins and carbapenems, and bacteremia related to mucositis with febrile neutropenia. These findings would assist physicians in deciding whether glycopeptide antibiotics should be included as an empiric antibiotic therapy in patients with suspected enterococcal infections and also those with persistent neutropenic fever refractory to fourth generation cephalosporin. A few cases of MALDI-TOF MS-identified Enterococcus faecium that turned out ampicillin-sensitive were also described to emphasize the importance of taking epidemiological aspects of patients into considerations when deciding initial antimicrobial treatment.
Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan. Electronic address: sh2440@cc.saga-u.ac.jp.
Yohei
Y
Hamada
Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan.
Hiroki
H
Magarifuchi
Clinical Laboratory, Saga University Hospital, Japan.
Megumi
M
Oho
Clinical Laboratory, Saga University Hospital, Japan.
Koji
K
Kusaba
Department of Medical Technology and Sciences, International University of Health and Welfare, Japan.
Zenzo
Z
Nagasawa
Division of Infection Control and Prevention, Saga Prefectural Medical Center Koseikan, Japan.
Mami
M
Fukuoka
Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan.
Hiroki
H
Yamakuchi
Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan.
Toshiharu
T
Urakami
Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan.
Yosuke
Y
Aoki
D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D014640:Vancomycin / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000667:Ampicillin
Ampicillin; Bacteremia; Enterococcus; Vancomycin