Unusual Urinary Pathogen Characterized
New findings could help guide management of vancomycin-resistant, ampicillin-sensitive E. faecalis.
VRASEF is not a common organism cultured from urine, and there is debate about how best to medically manage patients who are culture positive for the pathogen. The epidemiology, risk factors, and drug of choice to treat UTIs caused by these bacteria are not well documented.
Sandhya Nalmas, MD, and
Common comorbid conditions included renal insufficiency (12 patients), diabetes mellitus (10 patients), immunosuppression (nine patients) and malignancy (seven patients). The most common antibiotics used for treatment one month before positive urine cultures were levaquin (22 patients [71%]) and vancomycin (13 patients [42%]). There were no significant differences between UTI group and the non-UTI group in terms of age, sex, diabetes mellitus, renal insufficiency, nursing home residency, Foley catheter use, number of days hospitalized, and antibiotic treatments. Patients with UTIs, however, were more likely to have underlying malignancy compared with non-UTI patients.
No VRASEF bacteremias were observed in either group and among the 18 patients with UTIs, the researchers reported here at the annual meeting of the Infectious Diseases Society of America. Seven patients (38%) received linezolid, three (17%) received ampicillin, and seven (38%) receiving other antibiotics, such as doxycycline, primaxin, and levaquin. Patients with UTIs and diabetes mellitus were more often treated with linezolid compared with non-diabetic patients with UTIs. During the study period, four patients with UTIs died, but none of the deaths was related to the UTI.
“Whenever you see a urine culture that is positive for VRASEF it does not necessarily mean it is infectious,” Dr. Nalmas said. “Physicians need to categorize whether the patients really have UTIs versus a non-UTI. Depending on the organism and the sensitivity, we need to consider the appropriate drug. Just because we are using an expensive drug it doesn't mean it is going to clear better than if the patient was treated with simple ampicillin.”
The study underscores the importance of using antibiotics appropriately, which could help reduce development of multidrug resistant bacteria, she said.