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JAC Advance Access originally published online on November 1, 2002
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Journal of Antimicrobial Chemotherapy (2002) 50, 1003-1009
© 2002 The British Society for Antimicrobial Chemotherapy

Risk factors associated with ampicillin resistance in patients with bacteraemia caused by Enterococcus faecium

Jesús Fortún1,*, Teresa M. Coque2, Pilar Martín-Dávila1, Leonor Moreno1, Rafael Cantón2, Elena Loza2, Fernando Baquero2 and Santiago Moreno1

Departments of 1 Infectious Diseases and 2 Microbiology, Ramón y Cajal Hospital, University of Alcalá, Crtra Colmenar Km 9.1, Madrid 28034, Spain

Received 5 April 2002; returned 3 July 2002; revised 9 August 2002; accepted 22 August 2002

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 ß-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.

* Corresponding author. Tel: +34-91-336-8709; Fax: +34-91-336-8792; E-mail: fortun{at}mi.madritel.es


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