AI Article Synopsis
- The study examines the characteristics of ampicillin-resistant, vancomycin-susceptible Enterococcus faecium, particularly focusing on its linkage to potential future vancomycin resistance.
- The researchers reviewed medical records from 1994 to 1999, identifying 49 cases of E. faecium bacteraemia, with 29 being ampicillin-resistant and 20 susceptible.
- The findings revealed that prior beta-lactam antibiotic use and urinary catheterization were risk factors for ampicillin resistance, while high APACHE II scores indicated a higher mortality rate, although overall mortality rates were similar between resistant and susceptible strains.
Article Abstract
Epidemiological characteristics of ampicillin-resistant, vancomycin-susceptible Enterococcus faecium are not well known. Recently, these strains have been proposed as the substratum for the later appearance of vancomycin-resistant E. faecium. To analyse this problem, the medical charts of patients with bacteraemia caused by E. faecium diagnosed in our institution during a 6 year period (1994-1999) were reviewed. Demographic data, clinical characteristics, antibiotic exposure and outcome were compared among patients with ampicillin-resistant (MIC > 16 mg/L, NCCLS criteria) and ampicillin-susceptible strains. Clonality between different strains was analysed by pulsed-field gel electrophoresis (PFGE). We evaluated 49 cases of E. faecium bacteraemia; 29 patients with ampicillin-resistant strains and 20 patients with -susceptible strains were identified. By logistic regression analysis, only previous administration of beta-lactams (OR: 6.3; 95% CI: 1.12-20.0) and urinary catheterization (OR:4.2; 95% CI: 1.3-30.0) were identified as predictors of ampicillin resistance in enterococcal bacteraemic patients. An elevated APACHE II score was the only independent factor associated with mortality in enterococcal bacteraemia (OR:13.5; 95% CI: 1.04-175.4). PFGE analysis revealed a strong association between specific ampicillin-resistant clones and the location of patients during hospitalization, suggesting nosocomial transmission. Bacteraemia caused by ampicillin-resistant enterococci was not associated with increased mortality when compared with bacteraemias caused by ampicillin-susceptible strains.
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| http://dx.doi.org/10.1093/jac/dkf216 | DOI Listing |
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