Xie Ouli, Slavin Monica A, Teh Benjamin W, Bajel Ashish, Douglas Abby P, Worth Leon J
Victorian Infectious Disease Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.
BMC Infect Dis. 2020 Mar 18;20(1):228. doi: 10.1186/s12879-020-04952-5.
Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients.
A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008-2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission.
Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days.
VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.
耐万古霉素肠球菌（VRE）是免疫功能低下人群感染的重要原因。很少有研究描述vanB型VRE感染的特征。我们试图描述恶性血液学和肿瘤学患者中以vanB为主的环境下VRE血流感染（BSI）的流行病学、治疗及转归。
在澳大利亚两个大型中心进行了一项回顾性研究，时间跨度为6年（2008 - 2014年）。可评估的转归指标包括BSI发生后48小时内入住重症监护病房（ICU）、全因死亡率（7天和30天）以及住院时间。
总体而言，96例患者共发生106次BSI发作，主要为粪肠球菌vanB型（105/106，99%）。在BSI发生前，抗生素的中位使用时间为17天，76/96（79%）的患者在BSI发作时处于中性粒细胞减少状态。在BSI发作前接受筛查的患者中，49/72（68%）被发现有定植。治疗药物包括替考拉宁（59例）、利奈唑胺（6例）、达托霉素（2例）以及序贯/联合用药（21例）。30天死亡率为31%。多变量分析显示，替考拉宁与30天死亡率无关。
在vanB流行环境中的VRE BSI发生在大量先前使用抗生素的背景下，且与30天的高死亡率相关。针对性筛查发现68%的患者在BSI发生前有定植。替考拉宁治疗与较差的转归无关，对于癌症患者的vanB型VRE BSI值得进一步研究。
