Vancomycin-resistant enterococcal bacteremia in neutropenic patients with cancer

BACKGROUND: The aim of this study was to determine the incidence, clinical characteristics and outcome of vancomycin-resistant enterococcal bacteremia . PATIENTS AND METHODS: We included all cases of enterococcal bacteremia in n eutropenic cancer patients documented between January 1986 and December 199 5 in a 1,000-bed university hospital, where a prospective surveillance of a ll cases of bacteremia is regularly done. Molecular typing was performed on all vancomycin-resistant strains with the analysis of chromosomic DNA by m acrorestriction. RESULTS: Seventeen cases of enterococcal bacteremia were documented. Seven (41%) were caused by vancomycin-resistant strains (E. facium 3 and E. galli narum 4), six of which ocurred in the last 5 years of the study period. The average age of patients was 43 years (18-69) and most of them had acute le ukemia. Eighty percent of these patients had received vancomycin and/or cep halosporins within 2 weeks prior to bacteremia. Previous administration of antibiotics was more frequent in patients with bacteremia caused by vancomy cin-resistant enterococci than in those with bacteremia caused by susceptib le strains (86% vs 30%; p < 0.05). The mean number of previous antibiotics (2.4 vs 0.8; p < 0.05) as well as days of treatment (13.6 vs 4.3; p = 0.05) were also higher among patients with resistant enterococcal bacteremia. Th e overall mortality was 57%. CONCLUSIONS: This study shows the emergence of sporadic cases of bacteremia caused by vancomycin-resistant enterococci in neutropenic cancer patients in our area. This fact seems to be related with the previous administration of antibiotics and advices that a rational use of these agents is needed.