NICE, FRANCE — Much like their American counterparts, European clinicians are now struggling with vancomycin-resistant Enterococci.
The number of vancomycin-resistant Enterococci has increased dramatically from 1.5% in 2001 to 25% in 2005 in some areas of southwestern Germany. “This is a problem on the rise,” Dr. Christian Theilacker said at the 16th European Congress on Clinical Microbiology and Infectious Diseases.
During a prolonged outbreak that started in 2004, a total of 167 adult patients in a German tertiary care hospital were found to be colonized and/or infected with vancomycin-resistant Enterococci (VRE).
Invasive infection developed in 24 patients, Dr. Theilacker of University Hospital in Freiburg, Germany, and colleagues reported in a poster.
All VRE isolates were identified as E. faecium, and all infections were hospital acquired.
The infection was largely confined to high-risk patients, particularly those with uncontrolled cancer, according to a review of patient records.
Of the 21 cancer patients, 18 (86%) were not in remission; 9 (43%) had recently undergone allogeneic hematopoietic stem cell transplantation, and 14 (67%) had neutropenia at the time of the infection.
Other risk factors for infection were: comorbidities such as neoplasia, liver cirrhosis, and solid-organ transplantation; coinfections (present in 50% of patients); heavy pretreatment with antibiotics prior to infection; and lengthy hospitalization (median 28 days).
The findings confirmed what has been documented in U.S. studies conducted before the availability of newer antimicrobial agents with activity against VRE, Dr. Theilacker said in an interview.
What was disconcerting was that 50% of patients (12/24) died within 4 weeks of infection, despite the use of these newer antimicrobial agents. Four deaths (17%) were thought to be directly attributed to VRE infection by clinical judgment.
In addition, 17% of isolates were found to be resistant to linezolid, an antibiotic that has been found to be active against many drug-resistant strains of bacteria.
The isolates retained full susceptibility to quinupristin/dalfopristin, chloramphenicol, and doxycycline, suggesting that clinicians may want to consider using older agents such as doxycycline in these patients, Dr. Theilacker said.