Foo Hong, Chater Mathew, Maley Michael, van Hal Sebastiaan J
Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia Antibiotic Resistance and Mobile Genetic Elements Group, Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney, NSW, Australia
Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia.
J Antimicrob Chemother. 2014 Aug;69(8):2252-7. doi: 10.1093/jac/dku107. Epub 2014 Apr 16.
Enterococci are an important cause of nosocomial and community-acquired infections, with bacteraemia being one of the most common presentations. Although inappropriate antimicrobial therapy has been associated with poorer outcomes in Enterococcus faecalis (EF) bacteraemia, the impact of antimicrobial choice, namely β-lactam versus glycopeptide therapy, has not been well described. We sought to determine whether choice of antibiotic affects patient outcomes in EF bacteraemia.
This retrospective cohort study was conducted at Liverpool and Bankstown Lidcombe Hospitals, Sydney, Australia between 2006 and 2013. Medical records and laboratory data for consecutive EF bacteraemias were reviewed. Clinical and microbiological data were obtained for all patients who received appropriate antimicrobial therapy with either a β-lactam or a glycopeptide antibiotic. Outcomes and predictors of mortality were determined and treatment groups were compared.
One hundred and seventy-two episodes of clinically significant EF bacteraemias received appropriate antimicrobial therapy with a β-lactam (n = 126) or a glycopeptide (n = 46). All-cause 30 day mortality was 15.1%, with mortality significantly higher in patients receiving glycopeptide therapy compared with β-lactam therapy (26.1% versus 11.1%, P = 0.015). Glycopeptide therapy remained an independent predictor of 30 day mortality [OR 2.46 (95% CI 1.01-6.02), P = 0.048]. APACHE II score [OR 1.10 (95% CI 1.02-1.18), P = 0.011] and malignancy [OR 2.58 (95% CI 1.03-6.49), P = 0.044] were also independent predictors of 30 day mortality.
Glycopeptide use is associated with increased mortality in patients with EF bacteraemia. In the treatment of β-lactam-susceptible EF bacteraemia, β-lactams should be considered first-line therapy.
肠球菌是医院获得性感染和社区获得性感染的重要病因，菌血症是最常见的表现之一。尽管不恰当的抗菌治疗与粪肠球菌（EF）菌血症患者预后较差有关，但抗菌药物选择（即β-内酰胺类与糖肽类治疗）的影响尚未得到充分描述。我们试图确定抗生素的选择是否会影响EF菌血症患者的预后。
这项回顾性队列研究于2006年至2013年在澳大利亚悉尼的利物浦医院和班克斯敦利德科姆医院进行。对连续性EF菌血症的病历和实验室数据进行了回顾。获取了所有接受β-内酰胺类或糖肽类抗生素适当抗菌治疗患者的临床和微生物学数据。确定了死亡率的结局和预测因素，并对治疗组进行了比较。
172例具有临床意义的EF菌血症发作接受了β-内酰胺类（n = 126）或糖肽类（n = 46）的适当抗菌治疗。全因30天死亡率为15.1%，接受糖肽类治疗的患者死亡率显著高于β-内酰胺类治疗（26.1%对11.1%，P = 0.015）。糖肽类治疗仍然是30天死亡率的独立预测因素[比值比2.46（95%可信区间1.01 - 6.02），P = 0.048]。急性生理与慢性健康状况评分系统II（APACHE II）评分[比值比1.10（95%可信区间1.02 - 1.18），P = 0.011]和恶性肿瘤[比值比2.58（95%可信区间1.03 - 6.49），P = 0.044]也是30天死亡率的独立预测因素。
使用糖肽类与EF菌血症患者死亡率增加有关。在治疗对β-内酰胺类敏感的EF菌血症时，β-内酰胺类应被视为一线治疗药物。
