Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Int J Antimicrob Agents. 2019 Jun;53(6):761-766. doi: 10.1016/j.ijantimicag.2019.03.023. Epub 2019 Apr 5.
The efficacy of vancomycin compared with ampicillin for enterococcal infections is unknown. This study aimed to compare their efficacy among patients with enterococcal bacteraemia.
Retrospective cohort study including adults aged >16 years with enterococcal bacteraemia, treated with β-lactam antibiotics active against Enterococcus spp. or vancomycin. Treatment classification was based on the first antibiotic used for >4 days in the 7 days after blood culture collection. Subgroup analyses for patients with penicillin-susceptible enterococcal bacteraemia and patients with monomicrobial penicillin-susceptible enterococcal bacteraemia were performed. The dependent variable was 30-day all-cause mortality. The propensity score (PS) for vancomycin treatment was calculated. Univariate and multi-variate analyses adjusted for PS were performed.
In total, 516 patients with enterococcal bacteraemia were included. Mortality was similar for patients treated with β-lactams (123/315, 39%) and vancomycin (82/201, 40.8%). Independent factors significantly associated with mortality included healthcare-associated or hospital-acquired infection, age, female sex, Charlson Comorbidity Index, dialysis, SOFA score and low albumin. After adjustment for these factors and PS, the odds ratio (OR) for death in patients treated with vancomycin was 0.95 [95% confidence interval (CI) 0.56-1.59]. Results were similar among patients with penicillin-susceptible enterococcal bacteraemia and patients with monomicrobial penicillin-susceptible enterococcal bacteraemia (n=237, adjusted OR 0.59, 95% CI 0.25-1.43).
No difference in mortality was observed following treatment with a β-lactam or vancomycin among patients with enterococcal bacteraemia. Vancomycin is not recommended for the treatment of penicillin-susceptible enterococcal infections; however, when needed, it is not inferior to β-lactams and the addition of a β-lactam is not necessary.
万古霉素治疗肠球菌感染的疗效优于氨苄西林，但肠球菌菌血症患者中两种药物疗效的比较尚不清楚。本研究旨在比较这两种药物治疗肠球菌菌血症患者的疗效。
回顾性队列研究纳入年龄＞16 岁、有肠球菌菌血症、接受对肠球菌有活性的β-内酰胺类抗生素或万古霉素治疗的成年人。治疗分类基于血培养采集后 7 天内使用＞4 天的首种抗生素。对青霉素敏感的肠球菌菌血症患者和单一青霉素敏感的肠球菌菌血症患者进行亚组分析。主要观察指标为 30 天全因死亡率。计算万古霉素治疗的倾向评分（PS）。进行了调整 PS 的单变量和多变量分析。
共纳入 516 例肠球菌菌血症患者。β-内酰胺类药物（315 例患者中有 123 例，39%）和万古霉素（201 例患者中有 82 例，40.8%）治疗患者的死亡率相似。与死亡率显著相关的独立因素包括医疗保健相关或医院获得性感染、年龄、女性、Charlson 合并症指数、透析、SOFA 评分和低白蛋白。在调整这些因素和 PS 后，万古霉素治疗患者死亡的优势比（OR）为 0.95（95%置信区间[CI]，0.56-1.59）。青霉素敏感的肠球菌菌血症患者和单一青霉素敏感的肠球菌菌血症患者（n=237）的结果相似（调整 OR 0.59，95%CI，0.25-1.43）。
肠球菌菌血症患者接受β-内酰胺类药物或万古霉素治疗后，死亡率无差异。不推荐使用万古霉素治疗青霉素敏感的肠球菌感染；然而，在需要时，其并不劣于β-内酰胺类药物，且无需联合使用β-内酰胺类药物。
