K-3432. Five years of Enterococcal Bacteremia at Auckland City Hospital, Auckland, New Zealand
Session: Poster Session: Enterococci/URE
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: The epidemiology of invasive enterococcal disease is changing; Enterococcus faecium has emerged as an important nosocomial pathogen and antimicrobial resistance is increasing. Methods: A retrospective review of demographic, microbiological and clinical data on patients aged over 15 years with Enterococcus faecalis or E. faecium bacteremia admitted to Auckland City Hospital over a five year period from 1 June 2002 to 31 May 2007. Results: 212 patients had E. faecalis or E. faecium isolated from blood cultures, of whom 7 were excluded from analysis. E. faecalis accounted for 86% (176/205) and E. faecium 14% (29/205). High-level gentamicin resistance was found in 38.0% (65/171) of E. faecalis isolates, and 25% (7/28) E. faecium isolates (p=NS). 69% (20/29) of E. faecium isolates were resistant to amoxycillin. No vancomycin-resistant enterococci were isolated. 27% (56/205) of cases were community-associated and 73% (149/205) healthcare-associated. 86% (176/205) of patients had one or more comorbidities, with impaired renal function in 48%, malignancy in 32% and prior organ transplantation in 15%. 7 day mortality was 13% (27/205) and 30 day mortality 25% (52/205). On multivariate analysis, 7 day mortality was significantly associated with cirrhosis; and not receiving active antibiotic therapy. 30 day mortality was significantly associated with E. faecium bacteraemia; not receiving active antibiotic therapy; cirrhosis; and malignancy. High-level gentamicin resistance was associated with 30 day mortality on single covariate analysis, but this did not persist in multivariable analysis.
Conclusions: In patients with E. faecalis or E. faecium bacteremia:
1. High-level gentamicin resistance is not associated with increased mortality
2. The 30 day mortality is 25% and is highest with E. faecium bacteraemia
3. Healthcare-association is present in >70% 4. Most patients will have significant comorbidity
Arlo Upton, Clinical studies unit, Sally Roberts, Labplus, auckland city hospital, Stephen McBride, Auckland city hospital, Auckland, New Zealand and  S. J. McBride, None.

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