Bucheli E, Kralidis G, Boggian K, Cusini A, Garzoni C, Manuel O, Meylan P R A, Mueller N J, Khanna N, van Delden C, Berger C, Koller M T, Weisser M
Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Transpl Infect Dis. 2014 Feb;16(1):26-36. doi: 10.1111/tid.12168. Epub 2013 Dec 16.
The burden of enterococcal infections has increased over the last decades with vancomycin-resistant enterococci (VRE) being a major health problem. Solid organ transplantation is considered as a risk factor. However, little is known about the relevance of enterococci in solid organ transplantation recipients in areas with a low VRE prevalence.
We examined the epidemiology of enterococcal events in patients followed in the Swiss Transplant Cohort Study between May 2008 and September 2011 and analyzed risk factors for infection, aminopenicillin resistance, treatment, and outcome.
Of the 1234 patients, 255 (20.7%) suffered from 392 enterococcal events (185 [47.2%] infections, 205 [52.3%] colonizations, and 2 events with missing clinical information). Only 2 isolates were VRE. The highest infection rates were found early after liver transplantation (0.24/person-year) consisting in 58.6% of Enterococcus faecium. The highest colonization rates were documented in lung transplant recipients (0.33/person-year), with 46.5% E. faecium. Age, prophylaxis with a betalactam antibiotic, and liver transplantation were significantly associated with infection. Previous antibiotic treatment, intensive care unit stay, and lung transplantation were associated with aminopenicillin resistance. Only 4/205 (2%) colonization events led to an infection. Adequate treatment did not affect microbiological clearance rates. Overall mortality was 8%; no deaths were attributable to enterococcal events.
Enterococcal colonizations and infections are frequent in transplant recipients. Progression from colonization to infection is rare. Therefore, antibiotic treatment should be used restrictively in colonization. No increased mortality because of enterococcal infection was noted.
在过去几十年中，肠球菌感染的负担有所增加，耐万古霉素肠球菌（VRE）成为一个主要的健康问题。实体器官移植被认为是一个危险因素。然而，在VRE患病率较低的地区，关于肠球菌在实体器官移植受者中的相关性知之甚少。
我们在瑞士移植队列研究中对2008年5月至2011年9月期间随访的患者的肠球菌事件流行病学进行了研究，并分析了感染、氨基青霉素耐药性、治疗及预后的危险因素。
在1234例患者中，255例（20.7%）发生了392次肠球菌事件（185次[47.2%]感染、205次[52.3%]定植，以及2次临床信息缺失的事件）。仅2株分离菌为VRE。肝移植后早期感染率最高（0.24/人年），其中粪肠球菌占58.6%。肺移植受者的定植率最高（0.33/人年），粪肠球菌占46.5%。年龄、使用β-内酰胺类抗生素预防以及肝移植与感染显著相关。既往抗生素治疗、入住重症监护病房以及肺移植与氨基青霉素耐药性相关。仅4/205（2%）的定植事件导致感染。充分治疗并未影响微生物清除率。总体死亡率为8%；没有死亡归因于肠球菌事件。
移植受者中肠球菌定植和感染很常见。从定植进展为感染的情况很少见。因此，对于定植应谨慎使用抗生素治疗。未发现因肠球菌感染导致死亡率增加。
