Enterococcus avium bacteremia: a 12-year clinical experience with 53 patients

Abstract

Because Enterococcus avium is rarely isolated from blood cultures, little is known about the clinical features and outcomes of bacteremia caused by this organism, formerly called "group Q streptococcus". We retrospectively evaluated the clinical features and outcomes of patients with clinically significant bacteremia caused by E. avium presenting at a tertiary-care hospital in Korea between February 1997 and February 2009. We identified 53 patients over the 12-year period; of these, 27 (50.9%) had biliary and 13 (24.5%) had intra-abdominal E. avium infections. Thirty-six (67.9%) of the episodes were polymicrobial. Thirty-three (62.3%) episodes were nosocomial bloodstream infections and resistance to vancomycin was not observed. The crude mortality rate was 24.5% (13/53), and the E. avium bacteremia-related mortality rate was 11.3% (6/53). Multivariate analysis showed that underlying rapidly fatal or ultimately fatal disease (adjusted odds ratio [AOR], 6.92; 95% confidence interval [CI], 1.56-30.65; P = 0.011) and inadequate antimicrobial therapy (AOR, 7.29; CI, 1.27-41.93; P = 0.026) were independent risk factors for mortality. In summary, bacteremia due to E. avium was commonly of biliary or intraabdominal origin and was often associated with polymicrobial bacteremia. The crude mortality rate was considerable. Severe underlying conditions and inadequate antimicrobial therapy were significant and independent risk factors for crude patient mortality.

Bacteremia with an Iliopsoas Abscess and Osteomyelitis of the Femoral Head Caused by <i>Enterococcus avium</i> in a Patient with End-stage Kidney Disease

“…Based on these data, E. avium was the third most common enterococcal strain at our hospital, which indicates a relatively high prevalence of the pathogen in our area. Infections due to E. avium in other sites have also been reported (15,16,(21)(22)(23)(24)(25); however, there is only one previous case report of osteomyelitis, and that patient did not present with bacteremia (4). The present case is of interest because the patient presented with both bacteremia and an iliopsoas abscess with femoral head osteomyelitis caused by E. avium infection.…”

“…However, since the patient had a cutaneous ulcer on the left lower leg, the suspected site of entry was the skin. Despite the rare occurrence of this infection, approximately 20% of detected strains are resistant to penicillin or ampicillin, while resistance to vancomycin has not been previously reported (16). Empirically speaking, vancomycin is the antibiotic of choice for treating ampicillin-resistant E. avium.…”

A Case of Enterococcus Avium Colitis with Endoscopic Finding

“…Further studies are needed to define the pathogenesis and virulence of E avium prognosis. There have been some case reports about E avium bacteremia in Korea [10]. These observations suggest that E avium bacteremia most often originated from a gastrointestinal tract source.…”

“…Most of patients with bacteremia had serious underlying disease. E avium bacteremia reflecting the serious underlying disease and may be a marker of poor prognosis [10]. Further studies are needed to define the pathogenesis and virulence of E avium prognosis.…”

“…E.avium rarely infects man. Being regarded as a pathogen of low virulence, E. avium are seen mostly in patients with underly ing immunosuppressive conditions and are usually of a polymicrobial character because of the typically intra-abdominal source [3]. Although a few case reports of E. avium infection exist, no previous cases of stool culture positive for E. avium have been reported.…”