Glycopeptide resistance among coagulase-negative staphylococci that cause bacteremia: Epidemiological and clinical findings from a case-control study

A 1-year prospective case-control study (ratio of control patients to case patients, 3:1) was performed to assess the incidence, risk factors, and gen otypic patterns of bacteremia caused by glycopeptide-resistant coagulase-ne gative staphylococci (CoNS) and their correlation with hospital glycopeptid e use. Among 535 subjects with CoNS bacteremia, 20 subjects had a glycopept ide-resistant strain (19 strains were resistant to teicoplanin and 1 was re sistant to both teicoplanin and vancomycin). The percentage of resistant is olates recovered in 1 year was 8% in intensive care units and 3% and 2% in medical and surgical wards, respectively. Genotypic analysis of resistant s trains showed different patterns with a high degree of polymorphism. Use of glycopeptides in individual wards was not statistically associated with th e percentage of resistance. Previous exposure to beta -lactams and glycopep tides, multiple hospitalization in the previous year, and concomitant pneum onia were significantly associated with the onset of glycopeptide-resistant CoNS bacteremia. Mortality rates were 25% among case patients and 18% amon g control patients, and they were significantly higher among patients who p resented with concomitant pneumonia and a high Acute Physiology and Chronic Health Evaluation III score.