title: Clinical and microbiological features of bacteremia caused by Enterococcus faecalis.
abstract: BACKGROUND
  Enterococcus faecalis is a frequent etiologic agent of invasive infections in hospitalized patients. The aim of this study was to analyze clinical and microbiological features of bacteremia caused by E. faecalis.
  
  
  METHODS
  Between 2011 and 2013, significant bacteremia caused by E. faecalis in hospitalized patients was studied. Patient characteristics, comorbid conditions, and 14-day mortality were recorded. Virulence genes esp, gelE, and cylA; opsonophagocytosis resistance; resistance to bactericidal effect of normal serum; beta lactamase production; and susceptibility to ampicillin, vancomycin, teicoplanin, gentamicin, and streptomycin were investigated.
  
  
  RESULTS
  E. faecalis strains were recovered from 33 bacteremic patients. Polymicrobial bacteremia was diagnosed in 2 patients; 10 patients died. Virulence genes were found in strains from both deceased patients and survivors. Sources of bacteremia included urinary tract infections (36.4%), vascular catheters (15.1%), abscesses (9.1%), and unknown (48.5%). Underlying diseases included cancer (30.3%), diabetes (36.4%), cirrhosis (6.1%), renal (36.4%), and chronic obstructive pulmonary disease (2.0%). Co-morbidities included alcohol use (26.1%); glucocorticoid therapy (19.0%); prior antibiotic therapy (60.6%); and central venous (21.2%), arterial (12.1%), and urinary (63.6%) catheters. Also, 57.6% of patients came from the intensive care unit (ICU); 33.3% had mechanical ventilation. Significant mortality-associated conditions included polymicrobial bacteremia, oncological disease, APACHE II score ≤ 20, ICU stay, renal disease, central venous catheter, and mechanical ventilation.
  
  
  CONCLUSIONS
  Outcome of patients was associated with their status and not with the presence of virulence genes in E. faecalis strains. A significant percentage of bacteremia had undetermined origin. An alternate origin may be the gastrointestinal tract, through translocation.
authors.affiliation: Center for Biochemical Studies, Tandil, Argentina. mandrea73@hotmail.com.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ceci
authors.forename: Gastón
authors.initials: G
authors.lastname: Delpech
authors.forename: Mónica
authors.initials: M
authors.lastname: Sparo
authors.forename: Vito
authors.initials: V
authors.lastname: Mezzina
authors.forename: Sergio
authors.initials: S
authors.lastname: Sánchez Bruni
authors.forename: Beatriz
authors.initials: B
authors.lastname: Baldaccini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D001770:Blood Bactericidal Activity; D013293:Enterococcus faecalis / Q000187:drug effects / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010587:Phagocytosis; D011446:Prospective Studies; D016019:Survival Analysis; D037521:Virulence Factors / Q000235:genetics; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D037521:Virulence Factors; D001618:beta-Lactamases