A longitudinal analysis of enterococcal bacteraemias at a tertiary hospital in the ACT region

Dr Sharmin Nusrat1, Dr Jonathan Peake2, Dr Kathryn Daveson3

1The Canberra Hospital, Garran, Australia,
2The Canberra Hospital, Garran, Australia,
3The Canberra Hospital, Garran, Australia

Background:

Vancomycin resistant Enterococci (VRE) are known to evolve from clonal complexes that span the susceptible to resistant range.  Therefore it is important to understand the epidemiology of the entire Enterococcal spectrum to enact infection control measures for both strains. Whilst the Australian Group  on Antimicrobial Resistance (AGAR) classify Enterococcal disease by community and hospital onset, the ability to understand those with onset in the community but with healthcare exposure risks is limited.  We present a 10year longitudinal analysis of Enterococcal bacteraemia looking at the epidemiology of Enterococcus faecalis, faecium and VRE to inform future control measures.

Method and Results:

We identified 446 episodes of Enterococcal bacteraemias in our blood stream surveillance database over 10 years. (2008-2017). The majority were E. faecalis (n = 312, 69.9%) or E. faecium (n = 113, 25.3%).  E. faecalis was predominantly healthcare associated in contrast to AGAR datasets. Healthcare associated community-onset disease was seen but in lower numbers. 2 in 5 community onset E. faecalis bacteraemias were actually community onset but with identifiable healthcare links. There has been a steady rise of Enterococcal bacteraemias since 2009. VRE bacteraemia peaked in 2016. Mortality at 7 days has been stable over time. Bacteraemia related to gastrointestinal source remains the main cause of bacteraemia, the majority of which is healthcare associated.

Conclusion:

E. faecalis as a hospital onset pathogen is under appreciated with current surveillance definitions. In our institution, healthcare associated gastrointestinal bacteraemias offer a potential point of control for enterococal bactaeraemia, and possibly VRE colonisation reductions.


Biography:

I am a registrar at the Canberra Hospital doing infectious diseases as a first year trainee.

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