Risk factors and treatment outcomes of urinary tract infections due to Enterococcus

Risk factors and treatment outcomes of urinary tract infections due to Enterococcus

Sutthiporn Pattharachayakul, D. of Clinical Pharmacy, F. of Pharmaceutical Sci., PSU.
Paul C. Schreckenberger, Prof., D. of Pathology, U. of Illinois at Chicago, USA
Larry H. Danzinger, Prof., D. of Pharmacy Practice, U. of Illinois at Chicago, USA
Corresponding e-mail : spatth1@hotmail.com

Presented : 38th Annual Meeting of Infectious Disease Society of America, New Orleans, LA, USA, September 7-10, 2000
Key words : enterococci, ampicillin, UTIs

Objective : To evaluate patients with urinary tract infections (UTIs) due to Enterococcus with respect to risk factors and treatment outcome.

Methods : All patients with urine specimen positive for significant quantity of Enterococcus (>5x104 colonies/mL) during February-April 2000 were identified. Data collected prospectively from medical records and patient interviews included : demographic, risk factors, antimicrobial therapy, clinical outcome (CO) and microbiological outcome (MO).

Result : Evaluable data was available for 49/57 patients identified with enterococcal UTIs (22 outpatients vs 27 inpatients). Eighty-five percent of patients had at least one risk factors in acquiring an enterococcal UTI. These risk factors (RF) included genitourinary pathologic features (GPF), in-dwelling urinary catheter and cephalosporin exposure. Most patients (55%) had only 1 RF, 26% had 2 RF, 4% had all 3 RF. GPF was more frequent associated with enterococcal UTIs in outpatients than inpatients (74% Vs 14%). Conversely, indwelling urinary catheters were more likely to be associated with enterococcal UTIs in inpatients than outpatients. Thirty-eight of 49 patients had documented antibiotic treatment. The most common antibiotic selected were levofloxacin (50%) and ampicillin (45%). CO were assessed in 13 patients, of which 11 patients (85%) exhibited complete or partial response. MO were evaluated in 18 patients of which 14 patients (88%) were found to be either a definite or probable response. Only one patient had a concurrent enterococcal bacteremia and was successfully treated with ampicillin. Vancomycin resistant enterococci were isolated in 3 patients. Two of these patients were successfully treated with ampicillin and levofloxacin.

Conclusion : RF associated with enterococcal UTIs are different for outpatients and inpatients. Enterococcal UTIs were more common in outpatients with GPF but more common in inpatients with indwelling urinary catheters. Overall, enterococcal UTIs responded well to antibiotic therapy.

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