International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France.
International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France.
Clin Microbiol Infect. 2017 Nov;23(11):839-844. doi: 10.1016/j.cmi.2017.03.022. Epub 2017 Apr 1.
Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S. capitis-related LOS are poorly understood, but we hypothesized that S. capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S. capitis LOS and gut colonization.
We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S. capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models.
Eighty-three (36.2%) of 229 patients had S. capitis-positive stool culture, and 28 (12.2%) developed S. capitis LOS during hospitalization. Independent risk factors for S. capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100 g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S. capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p <0.001), particularly in the first week of life and in noncolonized neonates.
Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S. capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
耐多药、万古霉素不敏感的表皮葡萄球菌是全球早产儿晚发性败血症（LOS）的新兴病因。表皮葡萄球菌相关 LOS 的发病机制和危险因素了解甚少，但我们假设表皮葡萄球菌 LOS 是从肠道微生物群转移而来，而不是导管入侵。本研究旨在探讨表皮葡萄球菌 LOS 和肠道定植的危险因素。
我们进行了一项前瞻性单中心队列研究，纳入了 2011 年 6 月至 2012 年 1 月期间在法国里昂一家三级保健病房住院的患者。每周从粪便培养中确定表皮葡萄球菌的肠道定植情况。通过多变量 Cox 比例风险模型确定肠道定植和 LOS 的决定因素。
229 例患者中，83 例（36.2%）粪便培养表皮葡萄球菌阳性，28 例（12.2%）住院期间发生表皮葡萄球菌 LOS。表皮葡萄球菌 LOS 的独立危险因素包括万古霉素的既往应用，而与先前 LOS 无关（风险比 6.44，95%置信区间 2.15-19.3，p<0.001）和低出生体重（每增加 100g 风险比 0.72，95%置信区间 0.55-0.95，p=0.02）。万古霉素的既往应用也是表皮葡萄球菌定植的独立危险因素（风险比 3.45，95%置信区间 2.07-5.76，p<0.001），特别是在生命的第一周和未定植的新生儿中。
接受万古霉素治疗的新生儿发生耐万古霉素表皮葡萄球菌引起的 LOS 的风险更高。必须紧急优化万古霉素在新生儿中的使用，以限制缺乏替代抗生素的耐万古霉素菌株的选择。
