Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Infection. 2019 Jun;47(3):417-424. doi: 10.1007/s15010-018-1260-z. Epub 2018 Dec 19.
Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children.
We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes.
Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000).
Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.
肠球菌是免疫功能低下患者菌血症的常见原因。虽然耐万古霉素肠球菌（VRE）的增加使得适当的抗生素治疗变得困难，但免疫功能低下儿童中肠球菌菌血症的临床特征以及 VRE 感染对结局的影响很少有报道。
我们纳入了 2010 年至 2017 年间在发热性中性粒细胞减少症期间诊断为肠球菌菌血症的患有基础恶性肿瘤的儿童和青少年（<19 岁）。回顾性分析纳入患儿的病历，以评估肠球菌菌血症的临床特征以及 VRE 感染对结局的影响。
在 30 名患者中确定了 36 例肠球菌菌血症发作。在 11 例（30.6%）中发现了 VRE 感染；7 天和 30 天死亡率分别为 27.8%和 44.4%。急性淋巴细胞白血病（50.0%）和急性髓细胞白血病（30.6%）是最常见的基础疾病。3 例（8.3%）患者处于完全缓解期，47.2%和 36.1%的病例分别进行姑息性和再诱导化疗。在对万古霉素敏感的肠球菌感染患者中，经验性抗生素治疗有 64.0%是合适的，而在 VRE 感染患者中没有一例（p=0.001）。然而，两组患者的 30 天死亡率无显著差异（44.0%比 45.5%，p=1.000）。
大多数肠球菌菌血症发作发生在基础恶性肿瘤的晚期，死亡率仍然很高。预后似乎与基础疾病状况有关，而与分离肠球菌的万古霉素耐药性无关，尽管纳入的患者数量较少。
