Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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pISSN 2288-0585 eISSN 2288-6850

Antimicrobial Resistance of Enterococcal Isolates from Blood and Risk Factors for Vancomycin Resistant Enterococcal Bacteremia in a Tertiary Care University Hospital from 2003 to 2007

Original article

Annals of Clinical Microbiology (Ann Clin Microbiol) 2010 June, Volume 13, Issue 2, pages 59-67.

https://doi.org/10.5145/ACM.2010.13.2.59

Antimicrobial Resistance of Enterococcal Isolates from Blood and Risk Factors for Vancomycin Resistant Enterococcal Bacteremia in a Tertiary Care University Hospital from 2003 to 2007

Kyung Sun Park1, Myeong Hee Kim2, Tae Sung Park1, Jin Tae Suh1, Hee Joo Lee1
Department of Laboratory Medicine, 1Kyung Hee University Medical Center, 2Kyung Hee University East West Neo Medical Center, Kyung Hee University College of Mediicne, Seoul, Korea

Abstract

Background: In Korea, a sudden increase in vancomycin-resistant enterococci (VRE) infection has been noted since the late 1990s. This study was conducted to describe the antimicrobial resistances of enterococcal blood isolates and to identify risk factors associated with VRE bacteremia in a tertiary care university hospital over a recent five-year period. 

Methods: This study was conducted to analyze the antimicrobial susceptibilities of enterococcal blood isolates by year from January 2003 to December 2007. Multivariate logistic regression analysis was used to investigate factors associated with VRE bacteremia. 

Results: A total of 225 enterococcal strains (44.7% Enterococcus faecalis, 42.4% Enterococcus facium, 5.9% Enterococcus casseliflavus, and 4.7% Enterococcus gallinarum) were detected in blood, 55 of which (21.6%) were resistant to vancomycin. In 2004 and 2005, the resistance rates for vancomycin and teicoplanin (33.3% and 27.3%; 34.4% and 23.0%, respectively) increased. In 2003, 2006, and 2007, the resistance rates for vancomycin and teicoplanin (8.7% and 8.7%; 19.0% and 14.3%; 13.5% and 11.5%, respectively) decreased relative to those of the previous years. When 55 patients with VRE bacteremia were compared with 55 patients with vancomycin-susceptible enterococcal bacteremia using multivariate analysis, E. faecium bacteremia (OR 12.624, P<0.001) and enterococcal bacteremia caused by species other than E. faecium and E. faecalis (OR 21.473, P=0.011) were found to be statistical risk factors. Among several infection control activities, the restricted uses of vancomycin and quinupristin-dalfopristin decreased the vancomycin resistance rate from 27.78% to 15.50% (P=0.0257). 

Conclusion: VRE bacteremia would be effectively controlled via infection control activities based on studies regarding risk factors associated with VRE bacteremia. (Korean J Clin Microbiol 2010;13:59-67)

Keywords

 Vancomycin-resistant enterococcus (VRE), Enterococcal bacteremia, Antimicrobial resistance, Risk factors