1Department of Respiratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China.
2Department of Respiratory Medicine, the Third Medical Centre of Chinese PLA General Hospital, Yongding Road No.69, Beijing, 100853 China.
Antimicrob Resist Infect Control. 2019 Apr 24;8:65. doi: 10.1186/s13756-019-0523-5. eCollection 2019.
Coagulase-negative staphylococci (CoNS) are one of the major opportunistic pathogens and the incidence of CoNS bacteraemia is increasing. However, most of the CoNS-positive blood cultures are contaminants rather than true CoNS bacteraemia. In order to minimize contamination, we defined true CoNS bacteraemia as the patient that has two or more identical CoNS-positive blood cultures drawn within 48 h in this study and the objective of this study was to analyse the species distribution and antibiotic resistance and to identify risk factors for 30-day mortality of the true CoNS-bacteraemia.
By reviewing the electronic medical database, this study retrospectively analysed patients diagnosed as CoNS bacteraemia by blood cultures in a comprehensive tertiary care hospital in China from January 1, 2014, to December 31, 2017.
A total of 1241 patients with 1562 episodes of CoNS-positive blood cultures were recorded in the database but only 157 patients were finally diagnosed as true CoNS bacteraemia after contaminants were excluded. All these 157 patients (12.7%, 157/1241) had bacteraemia-related clinical symptoms. Among the 157 patients, the most common species were (40.8%), (36.3%) and (11.5%). The antimicrobial susceptibility tests showed that all CoNS had a high rate of resistance to penicillin (94.9%), oxacillin (93.6%) and erythromycin (92.4%). Resistance to gentamicin (22.3%) and rifampicin (10.8%) was low, and none of the bacteria were resistant to vancomycin or linezolid. The 30-day mortality of patients with CoNS bacteraemia was up to 12.7% (20/157), and the multivariate logistics regression analysis showed that chronic renal failure (OR 5.9, 95% CI 1.6-21.5, = 0.007) and chronic liver failure (OR 4.0, 95% CI 1.2-13.1, = 0.024) were both the significant independent risk factors for the 30-day mortality of CoNS bacteraemia.
and were the most common species in CoNS bacteraemia. All CoNS had high multi-drug resistance, but gentamicin and rifampicin had a relatively lower resistance and could be considered as alternative antibiotics for anti-CoNS bacteraemia in addition to vancomycin and linezolid. Additionally, patients with chronic renal failure or chronic liver failure have a higher 30-day mortality after the onset of CoNS bacteraemia.
凝固酶阴性葡萄球菌（CoNS）是一种主要的机会致病菌，CoNS 菌血症的发病率正在上升。然而，大多数 CoNS 阳性血培养物是污染菌，而不是真正的 CoNS 菌血症。为了最大限度地减少污染，我们将真正的 CoNS 菌血症定义为患者在 48 小时内两次或两次以上从相同的 CoNS 阳性血培养物中分离出两种或两种以上的菌株。本研究的目的是分析 CoNS 菌血症的种属分布和抗生素耐药性，并确定 30 天死亡率的危险因素。
通过回顾电子病历数据库，本研究回顾性分析了 2014 年 1 月 1 日至 2017 年 12 月 31 日在中国一家综合性三级医院通过血培养诊断为 CoNS 菌血症的患者。
数据库中记录了 1241 例 CoNS 阳性血培养物 1562 例，但排除污染菌后，最终仅诊断出 157 例真正的 CoNS 菌血症患者。所有这些 157 例患者（12.7%，157/1241）均有与菌血症相关的临床症状。在 157 例患者中，最常见的菌种是 （40.8%）、 （36.3%）和 （11.5%）。抗菌药物敏感性试验表明，所有 CoNS 对青霉素（94.9%）、苯唑西林（93.6%）和红霉素（92.4%）的耐药率均较高。对庆大霉素（22.3%）和利福平（10.8%）的耐药率较低，且无细菌对万古霉素或利奈唑胺耐药。CoNS 菌血症患者的 30 天死亡率高达 12.7%（20/157），多因素 logistic 回归分析显示，慢性肾衰竭（OR 5.9，95%CI 1.6-21.5， = 0.007）和慢性肝功能衰竭（OR 4.0，95%CI 1.2-13.1， = 0.024）是 CoNS 菌血症 30 天死亡率的独立危险因素。
和 是 CoNS 菌血症中最常见的菌种。所有 CoNS 均具有较高的多重耐药性，但庆大霉素和利福平的耐药性相对较低，除万古霉素和利奈唑胺外，还可考虑作为抗 CoNS 菌血症的替代抗生素。此外，发生 CoNS 菌血症后，合并慢性肾衰竭或慢性肝功能衰竭的患者 30 天死亡率较高。
