CLINICAL IMPLICATIONS OF ANTIBIOTIC-RESIS TANCE OF ENTEROCOCCI

Resistant strains: Enterococci, mainly E. faecalis and E. faecium, are the third or fourth microorganism causing nosocomial infections. They are naturally less susceptible to penicillins, and have a low level a minoglycoside resistance. Strains with a high level aminoglycoside res istance and resistant to glycopeptides have been appeared for the last 20 and 10 years, respectively. Frequency: Resistant strains are mainl y found in intensive care or oncology units, and immunocompromised pat ients, where the percentage of high level gentamicin resistance can re ach 24-40%. In France, the percentage of strains resistant to glycopep tides remains low, less than 0.5%, in opposition to United-States wher e resistance to glycopeptides can reach 14% in some intensive care uni ts. Risk factors: The occurence of several outbreaks suggests indirect contact transmission. They are favored by a long-duration hopitalisat ion, and prior use of cephalosporin or glycopeptide. Prevention: Becau se of the risk of dissemination, poor therapeutic options, and a possi ble diffusion of plasmids to other species such as staphylococci, prop hylactic strategies are necessary. This evolution emphasizes the need for appropriate antibiotic policies, and strict observation of guideli nes for preventing nosocomial transmission when a glycopeptide resista nt strain is identified. (C) 1997, Masson, Paris.