Glycopeptide Resistance among Coagulase-Negative Staphylococci that Cause Bacteremia: Epidemiological and Clinical Findings from a Case-Control Study

• Published in: Clinical infectious diseases Vol. 33; no. 10; pp. 1628 - 1635
• Main Authors: Tacconelli, Evelina, Tumbarello, Mario, de Gaetano Donati, Katleen, Bettio, Manola, Spanu, Teresa, Leone, Fiammetta, Sechi, Leonardo A., Zanetti, Stefania, Fadda, Giovanni, Cauda, Roberto
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.11.2001; University of Chicago Press
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobials; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Case-Control Studies; Coagulase - metabolism; Drug Resistance, Multiple, Bacterial; Genotype; Glycopeptides; Hospital admissions; Hospitalization; Human bacterial diseases; Humans; Incidence; Infections; Infectious diseases; Intensive care units; Major Articles; Male; Medical sciences; Microbial Sensitivity Tests - methods; Middle Aged; Pharmacology. Drug treatments; Predisposing factors; Risk Factors; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus; Staphylococcus - classification; Staphylococcus - drug effects; Staphylococcus - enzymology; Staphylococcus - genetics; Teicoplanin - pharmacology; Teicoplanin - therapeutic use; Treatment Outcome; Vancomycin Resistance; Typing; Drug susceptibility test; Genotype; Case control study; Epidemiology; Bacteremia; Staphylococcus; Incidence; Infection; Resistance; Symptomatology; Microbiological investigation; Surveillance; Glycopeptide; Risk factor; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/323676

A 1-year prospective case-control study (ratio of control patients to case patients, 3 : 1) was performed to assess the incidence, risk factors, and genotypic patterns of bacteremia caused by glycopeptide-resistant coagulase-negative staphylococci (CoNS) and their correlation with hospital glycopeptide use. Among 535 subjects with CoNS bacteremia, 20 subjects had a glycopeptide-resistant strain (19 strains were resistant to teicoplanin and 1 was resistant to both teicoplanin and vancomycin). The percentage of resistant isolates recovered in 1 year was 8% in intensive care units and 3% and 2% in medical and surgical wards, respectively. Genotypic analysis of resistant strains showed different patterns with a high degree of polymorphism. Use of glycopeptides in individual wards was not statistically associated with the percentage of resistance. Previous exposure to β-lactams and glycopeptides, multiple hospitalization in the previous year, and concomitant pneumonia were significantly associated with the onset of glycopeptide-resistant CoNS bacteremia. Mortality rates were 25% among case patients and 18% among control patients, and they were significantly higher among patients who presented with concomitant pneumonia and a high Acute Physiology and Chronic Health Evaluation III score.