[Enterococcus faecalis bacteremia].

Abstract

BACKGROUND: This study was prompted by the increasing role of E. faecalis in hospital acquired infections, their morbidity and mortality and the development of resistances. The aim of the study was to define the epidemiological features, the predictive factors of bacteremia and the mortality prognosis in a group of patients with E. faecalis bacteremia. METHODS: The clinical and epidemiological features on admission, after 3 days and one week of therapy and one month after therapy were evaluated in 57 cases of true E. faecalis bacteremia. The effectiveness of therapy was assessed by the rate of clinical and microbiological cures, deaths and survivals. RESULTS: The incidence of E. faecalis bacteremia was 5.9%. 78% of them were hospital acquired, with unknown source in 31%. Generally, they developed in surgical services and usually the patients had received antibiotic treatment or instrumentation. 63% of bacteremias were monomicrobial. Male sex, hospitalization (particularly in surgical or intensive care services), underlying disease of rapidly fatal prognosis, the previous use of third generation cephalosporins and/or ciprofloxacin, and previous instrumentation or surgery were found to be predictive factors of bacteremia. On the other hand, underlying disease with rapidly fatal prognosis, with initial poor or critical clinical condition, the previous use of wide spectrum antibiotics, polymicrobial bacteremia, and the presence of leukocytosis or complications were significantly associated with a higher mortality. The resistance rates ranged between 42% to kanamycin and 1% to amikacin. CONCLUSIONS: In view of the results, a better knowledge of the predictive and prognostic factors of E. faecalis bacteremia is required for prevention and treatment.