Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Hamburg, Germany.
Antimicrob Resist Infect Control. 2020 Jan 31;9(1):22. doi: 10.1186/s13756-020-0683-3.
The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT).
The outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycin-susceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days.
Mortality was similar between VRE- (n = 39) and VSE- (n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFA score during the 7-day-period before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14-1.53; and HR 1.18; CI 1.08-1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders.
Vancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population.
This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).
肠球菌血流感染（BSI）中万古霉素耐药的相关性仍存在争议。本研究旨在概述屎肠球菌万古霉素耐药对原位肝移植（OLT）后 BSI 患者结局的影响。
根据病历资料提取数据，比较发生屎肠球菌万古霉素耐药（VRE）和屎肠球菌万古霉素敏感（VSE）BSI 的 OLT 受者的结局。多变量回归分析确定了 30 天和 90 天后死亡率和不良结局（定义为死亡或延长重症监护停留时间）的危险因素。
30 天（p=0.44）和 90 天（p=0.39）时，VRE 组（n=39）和 VSE 组（n=138）的死亡率相似。不良结局也出现了类似的结果。BSI 发病前 7 天内平均 SOFA 评分是两个时间点死亡率的独立预测因素（HR 1.32；95%CI 1.14-1.53；和 HR 1.18；95%CI 1.08-1.28）。在调整混杂因素后，及时适当的抗生素治疗、近期 ICU 停留和万古霉素耐药并未影响结局。
在 OLT 后屎肠球菌菌血症患者中，万古霉素耐药并未影响结局。只有疾病的潜在严重程度在这个同质患者群体中预测了不良结局。
本研究在德国临床试验注册处（DRKS-ID：DRKS00013285）注册。
