Trends in the Incidence and Antibiotic Resistance of Enterococcal Bloodstream Isolates: A 7-Year Retrospective Multicenter Epidemiological Study in Italy

The spread of resistance to vancomycin and other last-resort drugs inEnterococcusspp. remains of concern. In Italy, surveillance data for enterococcal bloodstream isolates in humans are scant. The aim of our study was to assess the incidence trends of bacteremias due toEnterococcusspecies and their prevalence trends of antimicrobial resistance. We retrospectively included all consecutive not-duplicateEnterococcusspecies isolated from blood cultures, in patients from 11 Italian hospitals (2011-2017). Incidence was defined as the number of isolates per 10,000 patient-days, while resistance prevalence was defined as the number of resistant strains divided by the number of tested strains. We included 4,858 isolates (59%, 36%, and 5% due toEnterococcus faecalis,E. faecium, and otherEnterococcusspp., respectively). Over the study period, the incidence of bacteremias due toE. faecalis(incidence rate ratio [IRR]: 1.02, 95% confidence interval [CI]: 1.00-1.04,p = 0.008) andE. faeciumincreased (IRR: 1.03, 95% CI: 1.01-1.05,p < 0.001) alongside with the whole enterococcal bacteremias trend (IRR: 1.02, 95% CIs: 1.01-1.04,p = 0.002). A progressive increase in vancomycin-resistantE. faecium(VREfm) bacteremias was observed. Resistance to tigecycline and linezolid was rarely reported. The incidence of enterococcal bloodstream isolates is increasing in Italy, together with the prevalence of VREfm. Resistance to linezolid, a cornerstone drug used in the treatment of VRE bloodstream infection, remains negligible.