Trends in the Incidence and Antibiotic Resistance of Enterococcal Bloodstream Isolates: A 7-Year Retrospective Multicenter Epidemiological Study in Italy

Jacopo Monticelli, Stefano Di Bella, Daniele Roberto Giacobbe, Gerardino Amato, Roberta Maria Antonello, Eugenia Barone, Giovanni Brachelente, Marina Busetti, Davide Carcione, Edoardo Carretto, Pier Giulio Conaldi, Linda Degl'Innocenti, Filippo Del Puente, Anna Knezevich, Francesco Luzzaro, Maria Teresa Mainelli, Anna Marchese, Marcello Meledandri, Antonella Mencacci, Giuseppe MiragliottaFrancesco Monaco, Francesca Morabito, Adriana Mosca, Paola Nardini, Luigi Principe, Daniela Riggio, Valentina Viaggi, Claudio Viscoli, Roberto Luzzati

Research output: Contribution to journalArticlepeer-review

Abstract

The spread of resistance to vancomycin and other last-resort drugs in Enterococcus spp. remains of concern. In Italy, surveillance data for enterococcal bloodstream isolates in humans are scant. The aim of our study was to assess the incidence trends of bacteremias due to Enterococcus species and their prevalence trends of antimicrobial resistance. We retrospectively included all consecutive not-duplicate Enterococcus species isolated from blood cultures, in patients from 11 Italian hospitals (2011-2017). Incidence was defined as the number of isolates per 10,000 patient-days, while resistance prevalence was defined as the number of resistant strains divided by the number of tested strains. We included 4,858 isolates (59%, 36%, and 5% due to Enterococcus faecalis, E. faecium, and other Enterococcus spp., respectively). Over the study period, the incidence of bacteremias due to E. faecalis (incidence rate ratio [IRR]: 1.02, 95% confidence interval [CI]: 1.00-1.04, p = 0.008) and E. faecium increased (IRR: 1.03, 95% CI: 1.01-1.05, p < 0.001) alongside with the whole enterococcal bacteremias trend (IRR: 1.02, 95% CIs: 1.01-1.04, p = 0.002). A progressive increase in vancomycin-resistant E. faecium (VREfm) bacteremias was observed. Resistance to tigecycline and linezolid was rarely reported. The incidence of enterococcal bloodstream isolates is increasing in Italy, together with the prevalence of VREfm. Resistance to linezolid, a cornerstone drug used in the treatment of VRE bloodstream infection, remains negligible.

Original languageEnglish
JournalMicrobial drug resistance (Larchmont, N.Y.)
DOIs
Publication statusE-pub ahead of print - Sep 18 2020

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