A bacteria with growing resistance to the broad-spectrum antibiotic vancomycin -- Enterococcus faecium -- has been implicated as a major cause of hospital-acquired infections.
In a study of 53 patients with enterococcal infections, Valentina Stosor, M.D., and colleagues found that all 21 cases of vancomycin-resistant infections were acquired in the hospital. All of the patients had received treatment with vancomycin previously.
Of this group, 75 percent of the patients died -- most from complications of the infection.
Twenty-five of the 32 patients whose infection responded to vancomycin also acquired the infection in the hospital. In this group, only 40 percent died from their illness.
Both groups of patients had been quite immunosuppressed, due to organ transplantation, cancer, HIV infection and other causes, prior to developing the enterococcal infection. All patients had received a variety of broad-spectrum antibiotics before developing the bacteria in their blood. There were more HIV-infected patients who responded to vancomycin, an unexpected finding that the researchers are continuing to investigate.
In addition to a higher mortality rate, vancomycin-resistant enterococcal infections cost on average about $25,000 more to treat and doubled the patients' length of stay in the hospital.
According to Gary A. Noskin, M.D., assistant professor of medicine and one of the researchers on the Northwestern study, these results raise important issues regarding overuse of antibiotics by physicians among hospitalized patients.
"Antibiotic-resistant bacteria have emerged as a serious problem among hospitalized patients. In addition to the high mortality associated with these infections, they are very costly to treat," Noskin said.
Noskin believes that appropriate antibiotic utilization is important for outpatients as well. He said that physicians must educate their patients about the proper use of these drugs to help prevent the development of antibiotic resistance.
Furthermore, he said, physicians, patients, pharmaceutical companies and regulatory agencies must all work together to ensure effective antibiotics for the future.
(Editor's note: Stosor and Noskin can be reached prior to Sept. 16 at 312-908-7986 or e-mail at gnoskin@nwu.edu. From Sept. 16-19, they can be reached through the American Society for Microbiology's press office at the New Orleans meeting at 504-544-6204.)