Enterococcal Bacteremia: Analysis of 75 Episodes

Gullberg, Robert M.; Homann, Scott R.; Phair, John P.

doi:10.1093/clinids/11.1.74

Cited by 111 publications

(58 citation statements)

References 55 publications

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“…The overall mortality among patients with enterococcal bacteremia was 46.2%, which is consistent with previous reports (30-68%) (3,4,15). Moreover, we found that mortality due to E. faecalis was similar regardless of the isolate's sensitivity to gentamicin, which is also consistent with the results of other studies (5,13,14).…”

Section: Discussionsupporting

confidence: 92%

“…This attribute suggests that Enterococcus and its resistance to antimicrobial drugs could continue to pose a challenge for both clinicians and hospital epidemiologists. In addition, the concomitant isolation of enterococci and other microorganisms in blood cultures has been reported in 24-49% of cases (3,4,14,15). This can make therapeutic decisions even more difficult and potentially worsen prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…We observed a polymicrobial bacteremia prevalence of 48% with no significant difference between HLGR and non-HLGR isolates. However, the association of gentamicin-resistant strains and polymicrobial infections has not been conclusively established in the literature (13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

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Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Vigani

Oliveira

Bratfich

et al. 2008

Braz J Med Biol Res

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Enterococcus spp bacteremia is associated with high mortality and the appearance of high-level gentamicin resistance (HLGR) created additional challenges for the treatment of these infections. We evaluated the epidemiological and clinical characteristics of patients with bacteremias caused by HLGR and non-HLGR Enterococcus faecalis isolates at a teaching hospital in the State of São Paulo, Brazil. Patients with bacteremia due to E. faecalis diagnosed between January 1999 and December 2003 were included in the study. We collected clinical, epidemiological, and microbiological data from medical records. Banked isolates were typed using pulsed-field gel electrophoresis. We identified 145 cases of E. faecalis bacteremia: 66 (45.5%) were caused by HLGR isolates and 79 (54.5%) by non-HLGR. In the univariate analysis, patients with HLGR infection were older, had higher rates of bladder catheterization, and more often had treatment with cephalosporin, quinolone, and/or carbapenem compared with patients with non-HLGR infection (P < 0.05). Multivariate analysis indicated that older age, hematological malignancy, and previous use of vancomycin were independently associated with HLGR (P < 0.05). Mortality rates were not significantly different among patients with HLGR (50%) and non-HLGR (43%) infections (P = 0.40). Of the 32 genotyped isolates, 16 were distributed into 6 main electrophoresis patterns and 16 others had distinct patterns. E. faecalis bacteremia is associated with high mortality and is frequently caused by HLGR isolates at this teaching hospital. The variability among genotyped isolates suggests that endogenous infections, rather than patient-to-patient transmission of E. faecalis, are more common at this institution.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Vigani

Oliveira

Bratfich

et al. 2008

Braz J Med Biol Res

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“…However, treatment for enterococcal bacteremia generally involves monotherapy with ampicillin or anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs, such as vancomycin, if the target strain of Enterococci is ampicillin-resistant. Clinical studies suggest that there may be no advantages for combination therapy over monotherapy in cases of enterococcal infection without endocarditis (29,30). In the present case, the ampicillin-resistant E. avium strain, which was detected on Days 1, 2 and 3, had a vancomycin minimal inhibitory concentration of !…”

Section: Discussionmentioning

confidence: 59%

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

2015

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A 70-year-old man on hemodialysis for end-stage kidney disease due to polycystic kidney disease presented with hip pain on extension and a high C-reactive protein level. Further examinations revealed an iliopsoas abscess and femoral head osteomyelitis caused by Enterococcus avium (E. avium) detected in blood and pus cultures. Complete resolution of the infection with ampicillin-resistant E. avium required six months of vancomycin therapy and two surgical drainage procedures. There have been no previous case reports in which both blood and abscess cultures confirmed E. avium infection. Careful attention should be paid to the detection of non-specific symptoms in patients on hemodialysis, with blood cultures being essential in such cases.

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“…Çalışmamızda enterokok bakteriyemilerinin 56 (%59)'sı monomikrobiyal ve 39 (%41)'u polimikrobiyal bakteriyemiy- Kaynağı saptanabilen enterokok bakteriyemilerinde, en sık kaynak (%19-43) üriner sistemdir (9,11,17). Enterokok bakteriyemilerinin en sık kaynağı, Jang ve arkadaşları (18) tarafından safra yolu infeksiyonu; Conde-Estévez ve arkadaşları (19) ile Tan ve arkadaşları (20) tarafından ise santral venöz katetere bağlı kan dolaşımı infeksiyonu olarak saptanmıştır.…”

Section: İrdelemeunclassified

Evaluation of Risk Factors in Enterococcal Bloodstream Infections

Alkan¹,

Kuloğlu²,

Akata³

2016

Klimik Dergisi

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Objective: The aim of this retrospective case-control study was to determine the epidemiology and to evaluate risk factors for the development of enterococcal bloodstream infections and risk factors involved in mortality of adult patients in a tertiary care teaching hospital between February 2010 and February 2011. Methods: A total of 95 enterococcal bacteremia episodes were identified among 28 593 patients hospitalized during the study period. Control group was selected among patients who had no signs and symptoms of bacteremia and had negative blood cultures during the study period. In each case, there had to be two randomized control cases. Results:The most frequent isolates were Enterococcus faecalis (n=46, 48.4%) and E. faecium (n=45, 47.4%). There was only one vancomycin-resistant E. faecalis (vanA genotype) and one E. gallinarum. Eighty four (88.4%) patients were identified to have nosocomial infection. The most common primary sites were central venous catheter (32.7%) and urinary tract (14.7%). Six cases of infective endocarditis and two cases of meningitis due to enterococci were also identified. Polymicrobial bacteremia occurred in 39 (41%) patients. Immunosuppression, cardiovascular disease, chronic liver parenchymal disease, gastrointestinal tract disease, chronic renal failure, hemodialysis, an open wound, Foley catheter, surgery other than abdominal operation, antacid use, hospitalization in the last one month, prolonged hospitalization (>15 days), exposure to antimicrobial therapy prior to bacteremia and inappropriate empirical therapy were the risk factors significantly associated with enterococcal bloodstream infections. In the multivariate logistic regression analysis, three factors were independently associated with mortality including high Charlson index (p=0.000), intensive care unit admission (p=0.016) and isolation of E. faecium from blood cultures (p=0.49). Conclusions: It should be considered that severely ill patients with prolonged hospitalization, those undergoing invasive procedures or receiving inappropriate antibiotic therapy have a high risk of enterococcal bacteremia and those with serious underlying comorbidities are likely to be unresponsive to treatment and have a higher mortality. gallinarum).Olguların 84 (%88.4)'ünde hastane kökenli bakteriyemi saptandı. En sık primer infeksiyon kaynağı santral venöz kateter (%32.7) ve üriner sistem (%14.7) idi. Altı hastada bakteriyemiye eşlik eden infektif endokardit, iki hastada menenjit saptandı. Enterokok bakteriyemilerinin 39 (%41)'u polimikrobiyal bakteriyemiydi. İmmünosüpresyon, kardiyovasküler sistem hastalığı, kronik karaciğer parenkim hastalığı, gastrointestinal sistem hastalıkları, kronik böbrek yetmezliği, diyaliz tedavisi, açık yara, Foley sondası, abdominal cerrahi dışındaki cerrahi girişim, antasid kullanımı, son bir aylık dönemde hastanede yatış, hastanede yatış süresinin 15 günden fazla olması, bakteriyemi öncesi antibiyotik kullanımı ve uygun olmayan ampirik antibiyotik tedavisi, olgu grubunda anlamlı olarak daha...

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Enterococcal Bacteremia: Analysis of 75 Episodes

Cited by 111 publications

References 55 publications

Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

Evaluation of Risk Factors in Enterococcal Bloodstream Infections

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