Glycopeptide resistance among coagulase-negative staphylococci that cause bacteremia: epidemiological and clinical findings from a case-control study

Clin Infect Dis. 2001 Nov 15;33(10):1628-35. doi: 10.1086/323676. Epub 2001 Oct 5.

Abstract

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 beta-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.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Case-Control Studies
  • Coagulase / metabolism*
  • Drug Resistance, Multiple, Bacterial*
  • Genotype
  • Humans
  • Incidence
  • Male
  • Microbial Sensitivity Tests / methods
  • Middle Aged
  • Risk Factors
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Staphylococcus / classification
  • Staphylococcus / drug effects*
  • Staphylococcus / enzymology
  • Staphylococcus / genetics
  • Teicoplanin / pharmacology
  • Teicoplanin / therapeutic use
  • Treatment Outcome
  • Vancomycin Resistance

Substances

  • Anti-Bacterial Agents
  • Coagulase
  • Teicoplanin