Lavigne J-P, Marchandin H, Czarnecki E, Kaye C, Sotto A
Laboratoire de bactériologie, virologie, parasitologie, CHU de Nîmes, GHU de Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France.
Pathol Biol (Paris). 2005 Oct-Nov;53(8-9):539-45. doi: 10.1016/j.patbio.2005.06.005. Epub 2005 Aug 3.
The aim of this study was the description of enterococcal bacteremia and the evaluation of their resistance evolution to antibiotics and the virulence profile of these isolates.
We have studied all the bacteremia caused by Enterococcus spp. from the 1st of July 2003 until the 30th of June 2004 at Nîmes university hospital. For each isolate, population, clinical and microbiological data were collected. Multiplex PCR allowed for the identification of glycoprotein resistant phenotypes and furthermore, to identify the main virulence genes found in the enterococci.
Thirty-three strains were identified from 33 patients (60.6% male) with a median age of 68 years (median: 3-96). The vital prognostic was calculated in 63.6% of the cases (MacCabe > or =1); seven patients died during their hospitalization (21.2%). The infections were nosocomial in 60.6% of the cases. No epidemic was observed. The principal comorbidities were cardiovascular and digestive pathologies. In addition, 54.5% of patients had had a surgical intervention. Enterococcus faecalis (87.9%) was the cause of infection in the majority of cases followed by Enterococcus faecium. Most of the infections were monomicrobial (75.8%). E. faecalis was sensitive to amoxicillin and to glycopeptides but was resistant to norfloxacin, erythromycin and pristinamycin. The same observations were made for the E. faecium with the exception of amoxicillin. E. faecalis had the maximum number of virulence genes and E. faecium the least.
The enterococcal bacteremia had mainly a nosocomial origin. The isolates came from digestive tract flora but also from catheters. The mortality rate was 21.2%. A developing sensitivity to erythromycin and pristinamycin was observed in comparison to the data of the ONERBA (2002-2003). Only one isolate was resistant to glycopeptide. This was the first European E. faecium containing the vanD allele. This isolate proved fatal to the patient. The dark evolution of enterococcal bacteremia and their frequent nosocomial origin induce to promote studies intended for better knowing the risk factors of such infections.
本研究旨在描述肠球菌血症，评估其对抗生素耐药性的演变以及这些分离株的毒力特征。
我们研究了2003年7月1日至2004年6月30日在尼姆大学医院由肠球菌属引起的所有菌血症。对于每一株分离株，收集了人群、临床和微生物学数据。多重PCR用于鉴定糖蛋白耐药表型，并进一步鉴定肠球菌中发现的主要毒力基因。
从33例患者（男性占60.6%）中鉴定出33株菌株，中位年龄为68岁（范围：3 - 96岁）。63.6%的病例计算了生存预后（MacCabe≥1）；7例患者在住院期间死亡（21.2%）。60.6%的病例感染为医院获得性。未观察到流行情况。主要合并症为心血管和消化系统疾病。此外，54.5%的患者接受过手术干预。粪肠球菌（87.9%）是大多数病例的感染原因，其次是屎肠球菌。大多数感染为单一微生物感染（75.8%）。粪肠球菌对阿莫西林和糖肽类敏感，但对诺氟沙星、红霉素和 pristinamycin耐药。屎肠球菌除对阿莫西林外也有相同情况。粪肠球菌的毒力基因数量最多，屎肠球菌最少。
肠球菌血症主要起源于医院。分离株来自消化道菌群，但也来自导管。死亡率为21.2%。与ONERBA（2002 - 2003年）的数据相比，观察到对红霉素和pristinamycin的敏感性在增加。仅一株分离株对糖肽类耐药。这是欧洲首例含有vanD等位基因的屎肠球菌。该分离株导致患者死亡。肠球菌血症的不良演变及其频繁的医院获得性起源促使开展旨在更好了解此类感染危险因素的研究。
