Persistent vancomycin-resistant Enterococcus faecium bacteremia

Vancomycin-resistant Enterococcus faecium (VREF) is an important cause of infection in hospitalized patients. It was first isolated in our hospital in 1990. Between January 1, 1990, and May 1, 1995, six patients developed persistent VREF bacteremia (five adults, one child). Persistent bacteremia was defined as two or more positive blood cultures on different days. VREF isolates were resistant to ampicillin, vancomycin, gentamicin, and streptomycin but sensitive to chloramphenicol. The pediatric patient had AIDS and catheter-related VREF bacteremia that resolved after removal of the catheter. All adult patients had prolonged, complicated hospital admissions with multiple indwelling catheter insertions and extractions. VREF bacteremia persisted, despite removal of catheters and treatment with a variety of antibiotics, including chloramphenicol in four of five cases. Echocardiograms revealed no cardiac vegetations. Four adult patients died. Our limited experience suggests that the bacteriostatic agent chloramphenicol is of questionable efficacy against persistent VREF bacteremia. These cases suggest that persistent VREF bacteremia is associated with a poor outcome and highlight the need for effective bactericidal antibiotics against VREF.