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Journal of Clinical Microbiology, February 1998, p. 520-525, Vol. 36, No. 2
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Comparative Study of Bacteremias Caused by Enterococcus spp. with and without High-Level Resistance to Gentamicin

Francisco Javier Caballero-Granado,1,* J. M. Cisneros,1 R. Luque,2 M. Torres-Tortosa,3 F. Gamboa,4 F. Díez,5 J. L. Villanueva,6 R. Pérez-Cano,7 J. Pasquau,8 D. Merino,9 A. Menchero,10 D. Mora,11 M. A. López-Ruz,12 A. Vergara,13 and for the Grupo Andaluz Para El Estudio De Las Enfermedades Infecciosasdagger

Unidad de Enfermedades Infecciosas, Hospital Universitario "Virgen del Rocío,"1 and Unidad de Enfermedades Infecciosas, Hospital "de Valme," Seville,4 Servicio de Medicina Interna, Hospital de Motril, Motril,2 Servicio de Medicina Interna, Hospital Clínico de Granada,12 and Unidad de Enfermedades Infecciosas, Hospial Virgen de las Nieves,8 Granada, Unidad de Enfermedades Infecciosas, Hospital "Punta de Europa," Algeciras,3 Servicio de Medicina Interna, Hospital "Puerta del Mar,"7 and Servicio de Medicina Interna, Hospital de Puerto Real, Puerto Real,13 Cádiz, Servicio de Medicina Interna, Hospital "Torrecárdenas," Almería,5 Unidad de Enfermedades Infecciosas, Hospital "Reina Sofia," Córdoba,6 Servicio de Medicina Interna, Hospital "Juan Ramón Jiménez,"9 and Servicio de Medicina Interna, Hospital "Infanta Elena,"10 Huelva, and Servicio de Medicina Interna, Hospital "Carlos Haya," Málaga,11 Spain

Received 23 June 1997/Returned for modification 26 September 1997/Accepted 3 November 1997

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.

* Corresponding author. Mailing address: Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n. 41013 Seville, Spain. Phone: 34-5-4248029. Fax: 34-5-4248111. E-mail: fjcaba{at}cica.es.

dagger All authors are members of the Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

Journal of Clinical Microbiology, February 1998, p. 520-525, Vol. 36, No. 2
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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