JAC Advance Access published online on November 1, 2002
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkf216
© 2002 by The British Society for Antimicrobial Chemotherapy
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Original Paper
1 Department of Infectious
Diseases, Ramón y Cajal Hospital, University of Alcalá,
Crtra Colmenar Km 9.1, Madrid 28034, Spain
* Corresponding author. E-mail: fortun{at}mi.madritel.es.
Received 5 April 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
Risk factors associated with ampicillin resistance
in patients with bacteraemia caused by Enterococcus
faecium
2 Department of Microbiology,
Ramón y Cajal Hospital, University of Alcalá,
Crtra Colmenar Km 9.1, Madrid 28034, Spain
-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.
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