V. Peset et al., Epidemiological, microbiological, clinical, and prognostic factors of bacteremia caused by high-level vancomycin-resistant Enterococcus species, EUR J CL M, 19(10), 2000, pp. 742-749
Citations number
54
Categorie Soggetti
Microbiology
Journal title
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
A case-control study was performed between 1994 and 1996 in order to study
the epidemiological, microbiological, clinical, and prognostic features of
high-level vancomycin-resistant enterococcal bacteremia, Seventeen consecut
ive patients who had clinically significant bacteremia due to vancomycin-re
sistant enterococci (vanA genotype: 16 Enterococcus faecalis, 1 Enterococcu
s faecium) were compared with 169 who had vancomycin-susceptible enterococc
al bacteremia. The following were selected by multivariate analysis as inde
pendent risk factors that influenced the development of high-level vancomyc
in-resistant enterococcal bacteremia: prior glycopeptide therapy (P=0.049);
inclusion in a hemodialysis program (P=0.046); prior therapy with corticos
teroids or antineoplastic agents (P=0.029); and prior surgical treatment (P
=0.022). The following other factors were selected by univariate analysis:
tracheostomy (P=0.002); prolonged hospitalization (P=0.01): and any kind of
puncture (P=0.02). The crude associated-mortality rate was 13.4%. Gene amp
lification of vanA was positive for 17 strains of enterococci. Pulsed-field
gel electrophoresis of genomic DNA after SmaI digestion of vanA isolates r
evealed that one strain predominated (10 isolates), though at least four si
milar banding patterns were identified (6 isolates). The 16 strains closely
related to the outbreak were investigated further. The surgical intensive
care unit was the first and most involved service. The hospital outbreak of
vanA vancomycin-resistant enterococcal bacteremia occurred between 1994 an
d 1995 and was caused by Enterococcus faecalis. This is believed to be the
first and only such outbreak described in a Spanish hospital thus far.