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Determinants of Vancomycin Resistance and Mortality Rates in Enterococcal Bacteremia: A Prospective Multicenter Study

Emanuel N. Vergis, MD; Mary K. Hayden, MD; Joseph W. Chow, MD; David R. Snydman, MD; Marcus J. Zervos, MD; Peter K. Linden, MD; Marilyn M. Wagener, MPH; Barbara Schmitt, RN, BSN; and Robert R. Muder, MD
[+] Article and Author Information

From Veterans Affairs Medical Center–University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; Wayne State University School of Medicine and John D. Dingell Veterans Affairs Medical Center, Detroit, and William Beaumont Hospital, Royal Oak, Michigan; and New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts.


Acknowledgment: The authors thank Victor L. Yu, MD, for review of the manuscript.

Requests for Single Reprints: Robert R. Muder, MD, Infectious Disease Section, Veterans Affairs Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240.

Current Author Addresses: Dr. Vergis: Division of Infectious Diseases, University of Pittsburgh, Suite 3A, Falk Medical Building, 3601 Fifth Avenue, Pittsburgh, PA 15213.

Dr. Hayden and Ms. Schmitt: Section of Infectious Diseases, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612.

Dr. Chow: Division of Infectious Diseases, Wayne State University School of Medicine, 3990 John R, Detroit, MI 48201.

Dr. Snydman: Division of Infectious Diseases, New England Medical Center, 720 Washington Street, Box 238, Boston, MA 02111.

Dr. Zervos: William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073.

Dr. Linden: Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, 614 Scaife Hall, Pittsburgh, PA 15261.

Ms. Wagener and Dr. Muder: Infectious Disease Section, Veterans Affairs Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240.

Author Contributions: Conception and design: M.K. Hayden, J.W. Chow, D.R. Snydman, M.J. Zervos, P.K. Linden, R.R. Muder.

Analysis and interpretation of the data: E.N. Vergis, M.K. Hayden, J.W. Chow, D.R. Snydman, M.J. Zervos, M.M. Wagener, R.R. Muder.

Drafting of the article: E.N. Vergis, D.R. Snydman.

Critical revision of the article for important intellectual content: E.N. Vergis, M.K. Hayden, J.W. Chow, D.R. Snydman, M.J. Zervos, R.R. Muder.

Final approval of the article: E.N. Vergis, M.K. Hayden, J.W. Chow, D.R. Snydman, M.J. Zervos, P.K. Linden, M.M. Wagener, R.R. Muder.

Provision of study materials or patients: E.N. Vergis, M.K. Hayden, J.W. Chow, D.R. Snydman, M.J. Zervos, P.K. Linden, B.A. Schmitt.

Statistical expertise: M.M. Wagener.

Administrative, technical, or logistic support: M.J. Zervos, P.K. Linden, B.A. Schmitt, R.R. Muder.

Collection and assembly of data: E.N. Vergis, J.W. Chow, D.R. Snydman, M.J. Zervos, M.M. Wagener, B.A. Schmitt.


Ann Intern Med. 2001;135(7):484-492. doi:10.7326/0003-4819-135-7-200110020-00007
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Enterococcus species have become increasingly prominent as etiologic agents of nosocomial bacteremia (19). Enterococcal bacteremia has a mortality rate of 42% to 73% (1011) and is common among debilitated patients and those with severe underlying illnesses (56, 1217). Enterococci have low-level resistance to penicillins, aminoglycosides, and clindamycin and are intrinsically resistant to cephalosporins. Enterococci may acquire resistance to additional antibiotics, including β-lactams, aminoglycosides, and glycopeptides (18). Resistance to multiple antibiotics, in particular vancomycin coupled with high-level ampicillin and aminoglycoside, has been reported with increasing frequency (19). At present, more than 20% of enterococci isolated from intensive care units exhibit vancomycin resistance. The addition of vancomycin resistance to high-level ampicillin and aminoglycoside resistance limits available therapeutic options (20).

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Summary for Patients

Determinants of Vancomycin Resistance and Death in Enterococcal Bacteremia

The summary below is from the full report titled “Determinants of Vancomycin Resistance and Mortality Rates in Enterococcal Bacteremia. A Prospective Multicenter Study.” It is in the 2 October 2001 issue of Annals of Internal Medicine (volume 135, pages 484-492). The authors are EN Vergis, MK Hayden, JW Chow, DR Snydman, MJ Zervos, PK Linden, MM Wagener, B Schmitt, and RR Muder.

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