J Korean Med Sci.  2010 Jan;25(1):3-8. 10.3346/jkms.2010.25.1.3.

Clinical Features, Risk Factors and Outcomes of Bacteremia due to Enterococci with High-Level Gentamicin Resistance: Comparison with Bacteremia due to Enterococci without High-Level Gentamicin Resistance

• Jang HC
• Lee S
• Song KH
• Jeon JH
• Park WB
• Park SW
• Kim HB
• Kim NJ
• Kim EC
• Oh MD
• Choe KW

• KMID: 1713824
• DOI: http://doi.org/10.3346/jkms.2010.25.1.3

Abstract

High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.

Keyword

Enterococcus; Bacteremia; Gentamicins; Drug Therapy, Combination; HLGR; Mortality

MeSH Terms

Adolescent
Adult
Aged
Anti-Bacterial Agents/*pharmacology
Bacteremia/diagnosis/*etiology/*mortality
Cephalosporins/pharmacology
Cross Infection/complications
Drug Resistance, Bacterial
Enterococcus/*drug effects/isolation & purification
Female
Gentamicins/*pharmacology
Gram-Positive Bacterial Infections/diagnosis/*etiology/*mortality
Humans
Male
Middle Aged
Multivariate Analysis
Neutropenia/complications/mortality
Odds Ratio
Risk Factors
Severity of Illness Index
Treatment Outcome
Anti-Bacterial Agents
Cephalosporins
Gentamicins

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