Chloramphenicol treatment for vancomycin-resistant Enterococcus faecium bacteremia

Objective To evaluate the results of treating vancomycin-resistant Enteroco ccus faecium (VREF) bacteremia with chloramphenicol. Methods We retrospectively reviewed the charts of all adult patients with V REF bacteremia treated with chloramphenicol during the calendar year 1998 a t a 522-bed tertiary referral center in New York City. Patients were identi fied by reviewing microbiology laboratory records. Patients with clinically significant VREF bacteremia who received chloramphenicol for at least 48 h were included in the study. Clinical and microbiological outcomes were det ermined. Microbiological and molecular tests were performed on a small repr esentative sample of isolates to identify the presence of resistance mechan isms and to look for similarity among the isolates. Results Seven episodes of significant VREF bacteremia occurred in six patie nts. Mean age was 54 years. All patients had cancer and three had severe ne utropenia. Five of seven episodes were associated with chronic indwelling d evices, but in only one of these cases was the device removed. All isolates were susceptible to chloramphenicol in vitro. All six microbiologically ev aluable episodes had a favorable response to chloramphenicol treatment, and four of seven (57%) clinically evaluable episodes had favorable outcomes. Only one death ma); have been due to VREF bacteremia, so the maximal attrib utable mortality was 14%. The three representative samples that were tested further were indistinguishable from one another and they displayed no evid ence of resistance mechanisms. Conclusions In a cohort of severely ill cancer patients, chloramphenicol wa s effective in treating VREF bacteremia. The use of chloramphenicol should be considered in treating infections with this highly resistant organism, w here therapeutic options are limited.