Bacteraemia due to Enterococcus faecium in cancer patients: clinical features, antimicrobial susceptibility, and outcomes
Abstract number: P2244
Bodro M., Ayats J., Gudiol C., Garcia-Vidal C., Ardanuy C., Cisnal M., Cubero M., Ortí G., Antonio M., Carratalá J.
Objectives: We aimed to ascertain the characteristics, antimicrobial susceptibility, and outcomes of bacteremia due to E. faecium in cancer patients.
Methods: All episodes of E. faecium bacteremia prospectively documented in a university cancer center from Jan 2006 to November 2010 were included in the study. Antibiotic susceptibility was studied by a microdilution method (MicroScan®).
Results: We documented a total of 907 episodes of bloodstream infection. Among 370 episodes of Gram-positive bacteremia (41%), 60 episodes (16%) were caused by Enterococcus spp, and 29 of them (48,3%) were due to E. faecium. Eighteen patients were male (62%), mean age 57,8 yrs. (2383 yrs). Underlying diseases were hematological malignancies in 23 patients (79%) and solid tumors in 6. Nineteen episodes (65%) occurred in neutropenic patients. The most common sources of bacteremia were endogenous/unknown origin in 48% of cases, followed by intravascular catheter (21%) and cholangitis (17%). All patients had previously received two or more antimicrobial agents, specially cephalosporines and carbapenems. All isolates were vancomycin and teicoplanin susceptible. One strain was ampicillin susceptible. All the others strains had high level resistance to ampicillin, with MIC up to 256 mcg/mL. Rates of high level resistance to gentamycin and streptomycin were 28.6% and 96.4%, respectively. Twelve patients (41,%) received inadequate empirical antibiotic therapy, with cephalosporines in 17 cases, and carbapenems in 17 cases. Definitive antibiotic therapy consisted in vancomycin in 17 cases (59%), teicoplanin in 7 cases (24%) and daptomycin in 3 cases (10%). Among 4 patients (14%) with persistent bacteremia, 3 had catheter-related infection and 2 had received inadequate empirical antibiotic therapy. ICU admission was needed in 4 patients. Early mortality (<48 hours) was 14% and overall mortality (<30 days) was 38%.
Conclusions:E. faecium is a frequent cause of enterococcal bacteremia in cancer patients, mainly among those with hematological malignancies and neutropenia. In our institution, most E. faecium strains are highly resistant to ampicillin but susceptible to glycopeptides. Cancer patients with bacteremia receive frequently an inadequate empirical therapy and the infection is associated with high mortality rates. Further studies are needed to identify risk factors for E. faecium bloodstream infections.
|Session name:||Abstracts of 21st ECCMID / 27th ICC|
|Location:||Milan, Italy, 7 - 10 May 2011|
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