Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
Clin Microbiol Infect. 2014 Feb;20(2):145-51. doi: 10.1111/1469-0691.12236. Epub 2013 May 6.
Enterococci currently account for approximately 10% of all bacteraemias, reflecting remarkable changes in their epidemiology. However, population-based data of enterococcal bacteraemia are scarce. A population-based cohort study comprised all patients with a first episode of Enterococcus faecalis or Enterococcus faecium bacteraemia in two Danish regions during 2006-2009. We used data collected prospectively during clinical microbiological counselling and hospital registry data. We determined the incidence of mono- and polymicrobial bacteraemia and assessed clinical and microbiological characteristics as predictors of 30-day mortality in monomicrobial bacteraemia by logistic regression analysis. We identified 1145 bacteraemic patients, 700 (61%) of whom had monomicrobial bacteraemia. The incidence was 19.6/100 000 person-years (13.0/100 000 person-years for E. faecalis and 6.6/100 000 person-years for E. faecium). The majority of bacteraemias were hospital-acquired (E. faecalis, 45.7%; E. faecium, 85.2%). Urinary tract and intra-abdominal infections were the predominant foci for the two species, respectively. Infective endocarditis (IE) accounted for 25% of patients with community-acquired E. faecalis bacteraemia. Thirty-day mortality was 21.4% in patients with E. faecalis and 34.6% in patients with E. faecium. Predictors of 30-day mortality included age, co-morbidity and hospital-acquired bacteraemia. In addition, intra-abdominal infection, unknown focus and high-level gentamicin resistance were predictors of mortality in E. faecalis patients. E. faecium was associated with increased risk of mortality compared with E. faecalis. The study emphasizes the importance of enterococci both in terms of incidence and prognosis. The frequency of IE in patients with E. faecalis bacteraemia emphasizes the importance of echocardiography, especially in community-acquired cases.
肠球菌目前约占所有菌血症的 10%，反映了其流行病学的显著变化。然而，肠球菌菌血症的基于人群的数据却很少。本项基于人群的队列研究纳入了 2006-2009 年丹麦两个地区首次发生粪肠球菌或屎肠球菌菌血症的所有患者。我们使用临床微生物学咨询期间前瞻性收集的数据和医院登记数据。我们确定了单一致病菌血症和混合菌血症的发生率，并通过逻辑回归分析评估了临床和微生物学特征作为单一致病菌血症 30 天死亡率的预测因素。我们共确定了 1145 例菌血症患者，其中 700 例（61%）为单一致病菌血症。发病率为 19.6/100000 人年（粪肠球菌为 13.0/100000 人年，屎肠球菌为 6.6/100000 人年）。大多数菌血症为医院获得性（粪肠球菌 45.7%，屎肠球菌 85.2%）。尿路感染和腹腔内感染分别是两种菌的主要感染灶。感染性心内膜炎（IE）占社区获得性粪肠球菌菌血症患者的 25%。粪肠球菌和屎肠球菌患者的 30 天死亡率分别为 21.4%和 34.6%。30 天死亡率的预测因素包括年龄、合并症和医院获得性菌血症。此外，腹腔内感染、未知感染灶和高水平庆大霉素耐药是粪肠球菌患者死亡的预测因素。与粪肠球菌相比，屎肠球菌与死亡率增加相关。该研究强调了肠球菌在发病率和预后方面的重要性。粪肠球菌菌血症患者 IE 的发生率强调了超声心动图的重要性，尤其是在社区获得性病例中。
