Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA.
Antimicrob Agents Chemother. 2012 May;56(5):2452-8. doi: 10.1128/AAC.06299-11. Epub 2012 Feb 21.
In published studies, cohorts of patients with bacteremia due to vancomycin-resistant Enterococcus (VRE) have predominantly been infected with Enterococcus faecium. Little is known about the epidemiology and outcomes associated with bacteremia due to VR Enterococcus faecalis. A retrospective study of isolates obtained from January 2008 to October 2010 was conducted at Detroit Medical Center (DMC). Unique patients with blood cultures positive for VRE were reviewed. Outcomes were analyzed using logistic regression. During the study period, 105 cases of bacteremia due to VR E. faecalis and 197 cases of bacteremia due to VR E. faecium were identified. The mean age in the study cohort was 61.5 ± 15 years; 162 subjects (53.6%) were male. After controlling for a propensity score, bacteremia due to VR E. faecalis was associated with >2-fold-lower in-hospital mortality than bacteremia due to VR E. faecium. Interestingly, bacteremia due to VR E. faecalis was associated with longer hospital stay after VRE isolation, although total length of stay was similar for groups with VR E. faecalis and VR E. faecium. Bacteremia due to VR E. faecalis was associated with a >2-fold-lower risk for mortality than bacteremia due to VR E. faecium, possibly due to the availability of β-lactam therapeutics for treatment of VR E. faecalis.
在已发表的研究中，耐万古霉素肠球菌（VRE）菌血症患者队列主要感染粪肠球菌（Enterococcus faecium）。对于屎肠球菌（Enterococcus faecalis）引起的菌血症的流行病学和结局知之甚少。在底特律医疗中心（DMC）进行了一项回顾性研究，研究对象为 2008 年 1 月至 2010 年 10 月期间获得的分离株。对血培养阳性的 VRE 独特患者进行了回顾性分析。使用逻辑回归分析了结局。在研究期间，共发现 105 例屎肠球菌引起的菌血症和 197 例粪肠球菌引起的菌血症。研究队列的平均年龄为 61.5 ± 15 岁；162 名患者（53.6%）为男性。在控制倾向评分后，与粪肠球菌引起的菌血症相比，屎肠球菌引起的菌血症的院内死亡率降低了两倍以上。有趣的是，在 VRE 分离后，屎肠球菌引起的菌血症与更长的住院时间相关，尽管屎肠球菌和粪肠球菌组的总住院时间相似。与粪肠球菌引起的菌血症相比，屎肠球菌引起的菌血症的死亡率降低了两倍以上，这可能是由于治疗屎肠球菌的β-内酰胺类药物的可用性。
