Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.
University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.
Ann Hematol. 2019 Mar;98(3):763-773. doi: 10.1007/s00277-019-03607-z. Epub 2019 Jan 21.
Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.
肠球菌属是人类胃肠道的共生菌，具有引起侵袭性感染的能力。对于血液系统疾病患者，肠球菌血流感染（BSI）是一种严重的临床并发症，如果病原体对万古霉素耐药，情况甚至可能加重。因此，我们分析了耐万古霉素肠球菌（VRE）和万古霉素敏感肠球菌（VSE）引起的 BSI 对患者生存的影响。在这项回顾性单中心研究中，47 名患者的 BSI 由 VRE 引起，43 名患者的 BSI 由 VSE 引起。两组患者的基线特征相似。在感染相关特征方面，VRE BSI 组的 CRP 值升高和先前多药耐药菌定植的发生率增加。VSE 组中发现更多肠球菌侵袭性感染。主要终点，BSI 后 30 天的总生存率（OS），VRE BSI 患者明显低于 VSE BSI 患者（74.5% vs. 90.7%，p=0.039）。在多变量回归分析中，VRE BSI 和Charlson 合并症指数大于 4 是与 30 天死亡率相关的独立因素。此外，我们发现，具有额外替考拉宁耐药性的 VRE 与更低的 OS 呈趋势相关。
