Clinical course and prognostic factors of Enterococcal bacteremia

Background : Enterococci belong to Lancefield group D family of Streptococci. Generally, it has been considered that serious enterococcal infection was not so frequent because Background : Enterococci belong to Lancefield group D family of Streptococci. Generally, it has been considered that serious enterococcal infection was not so frequent because its virulence was low. However, as old age, neoplasms and organ transplantations have increased recently, the morbidity and mortality of enterococcal bacteremia have increased. This study was performed to observe the clinical outcome and prognostic factors of enterococcal bactermia. Methods : Fifty-four cases of enterococcal bacteremia diagnosed from January 1986 to December 1992 in Yonsei University College of Medicine were analysed with their clinical records retrospectively. Results : 1) Male to female ratio was 1.25:1 and mean age was 44.3 years old. Mean hospital days were 31.7 days and 32 cases(59.3%) were nosocomial infections. 2) 28 cases(50.2%) were Enterococcus faecalis. 14 cases (27.6%) were E. faecium and 3 cases(5.6%) were E. avium. 27 cases(50%) were polymicrobial infection and the associated organims were E. coli(11), Enterobacter(5), Klebsiella(5), S. epidermidis(5), and S. aureus(2). 3) Most patients had serious underlying diseases including neoplasm(17), heart disease(9), CNS disease(6), DM(2), CRF and renal allograft(3), and multiple trauma(2). 4) Probable portal of entry was identified in 28 patients : 22 cases(40.7%) were of GI origin and 6 cases(13%) were of GU origin. 5) In vitro susceptibility tests showd sensitivity rates of 79.1% to ampicillin, 85.0% to vancomycin, 67.0% to teicoplanin, ad 41.1% to ciprofloxacine. 6) The overall mortality rate was 42.6% and the mortality rate due to enterococcal bacteremia itself was 16.7%. Gender, polymicrobial infection, nosocomial infection, and previous antibiotics therapy were not related to the mortality. But the appropriate antibiotic therapy was significantly related to the mortality in cases of the fatal underlying disease. Conclusion : Our study suggests that the nature of enterococcal bacteremia is nosocomial and polymicrobial. It is common in patients with altered host defenses secondary to serious underlying disease. Considering its morbidity and mortality, in cases of the fatal underlying disease, correction of the underlying condition and the use of appropriate antibiotic are neccessary to dicrease the morbidity and mortality rates.ope