Suzuki Hiroyuki, Hase Ryota, Otsuka Yoshihito, Hosokawa Naoto
Department of Infectious Diseases, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba 2968602, Japan.
Department of Infectious Diseases, Narita Red Cross Hospital, 90-1, Iidacho, Narita, Chiba 2868523, Japan.
J Infect Chemother. 2017 Jun;23(6):390-393. doi: 10.1016/j.jiac.2017.03.009. Epub 2017 Apr 4.
The first aim of this study is to characterize the epidemiology of enterococcal bloodstream infections (BSIs) at a Japanese tertiary-care hospital. The second aim is to identify predictive factors for 30-day mortality.
We conducted a single center retrospective observational study. All patients with enterococcal BSI between 2005 and 2014 were enrolled. Univariate and multivariate analysis were performed to evaluate predictive factors for 30-day mortality.
A total of 410 patients with enterococcal BSI were enrolled. Enterococcus faecalis was identified in 200 patients (48.8%) and Enterococcus faecium in 124 patients (30.2%). Isolates were susceptible to ampicillin and vancomycin (67.3% and 97.8%, respectively). Isolates that were not susceptible to vancomycin were either Enterococcus casseliflavus or Enterococcus gallinarum. All strains of E. faecalis and 10.8% of E. faecium strains were susceptible to ampicillin. Thirty-day mortality was 24.8%. Predictive factors for 30-day mortality were Charlson Comorbidity Index (CCI) 1-2 (adjusted odds ratio [OR] 6.07, 95% confidence interval [CI]: 1.22-30.2), CCI 3-4 (adjusted OR 8.79, 95% CI: 1.70-45.4), CCI ≥5 (adjusted OR 17.6, 95% CI: 3.52-88.2), E. faecium bacteremia (adjusted OR 2.19, 95% CI: 1.27-3.76), Pitt Bacteremia Score (PBS) ≥5 (adjusted OR 15.1, 95% CI: 6.41-35.6), and source control (adjusted OR 0.39, 95% CI: 0.22-0.72).
Vancomycin-resistant strains of E. faecalis and E. faecium were not seen in this cohort. In addition, all strains of E. faecalis and 10.8% of E. faecium strains were susceptible to ampicillin. Predictive factors for 30-day mortality were CCI score, E. faecium bacteremia, PBS score, and source control.
本研究的首要目的是描述一家日本三级护理医院肠球菌血流感染（BSIs）的流行病学特征。第二个目的是确定30天死亡率的预测因素。
我们进行了一项单中心回顾性观察研究。纳入了2005年至2014年间所有患有肠球菌BSI的患者。进行单因素和多因素分析以评估30天死亡率的预测因素。
共纳入410例肠球菌BSI患者。200例（48.8%）患者分离出粪肠球菌，124例（30.2%）患者分离出屎肠球菌。分离株对氨苄西林和万古霉素敏感（分别为67.3%和97.8%）。对万古霉素不敏感的分离株为格氏肠球菌或鹑鸡肠球菌。所有粪肠球菌菌株和10.8%的屎肠球菌菌株对氨苄西林敏感。30天死亡率为24.8%。30天死亡率的预测因素为Charlson合并症指数（CCI）1 - 2（调整后比值比[OR] 6.07，95%置信区间[CI]：1.22 - 30.2）、CCI 3 - 4（调整后OR 8.79，95% CI：1.70 - 45.4）、CCI≥5（调整后OR 17.6，95% CI：3.52 - 88.2）、屎肠球菌菌血症（调整后OR 2.19，95% CI：1.27 - 3.76）、皮特菌血症评分（PBS）≥5（调整后OR 15.1，95% CI：6.41 - 35.6）以及源头控制（调整后OR 0.39，95% CI：0.22 - 0.72）。
该队列中未发现耐万古霉素的粪肠球菌和屎肠球菌菌株。此外，所有粪肠球菌菌株和10.8%的屎肠球菌菌株对氨苄西林敏感。30天死亡率的预测因素为CCI评分、屎肠球菌菌血症、PBS评分和源头控制。
