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耐万古霉素粪肠球菌和耐氨苄西林粪肠球菌菌血症的相关危险因素和结局:墨西哥城一家三级医疗中心的 10 年研究。

Risk factors and outcomes associated with vancomycin-resistant Enterococcus faecium and ampicillin-resistant Enterococcus faecalis bacteraemia: A 10-year study in a tertiary-care centre in Mexico City.

机构信息

Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico.

Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico.

出版信息

J Glob Antimicrob Resist. 2021 Mar;24:198-204. doi: 10.1016/j.jgar.2020.12.005. Epub 2020 Dec 24.

Abstract

OBJECTIVES

We sought to identify risk factors associated with vancomycin-resistant Enterococcus faecium (VRE) and ampicillin-resistant Enterococcus faecalis (ARE) bacteraemia, predictors of 30-day mortality, and 90-day recurrence-free survival according to resistance.

METHODS

We evaluated clinical records of patients with E. faecalis and E. faecium bacteraemia (2007-2017). We performed bivariate and multivariate logistic regression analyses to identify factors associated with VRE and ARE bacteraemia and predictors of 30-day mortality. A Kaplan-Meier estimate of 90-day recurrence-free survival was done.

RESULTS

We identified 192 and 147 E. faecium and E. faecalis bacteraemia episodes, respectively, of which 55.7% of E. faecium were VRE (94% vanA) and 12.2% of E. faecalis were ARE. Factors related to VRE bacteraemia were previous hospitalisation (aOR, 80.18, 95% CI 1.81-634), history of central venous catheter (aOR, 11.15, 95% CI 2.48-50.2) and endotracheal cannula use (aOR, 17.91, 95% CI 1.22-262.82). There was higher attributable mortality to VRE (28%, 95% CI 14-68%; P < 0.001) and ARE (10%, 95% CI 0.1-36%; P = 0.58) compared with their susceptible counterparts. APACHE II (aOR, 1.45, 95% CI 1.26-1.66) and history of chemotherapy (aOR, 3.52, 95% CI 1.09-11.39) were predictors of E. faecium bacteraemia 30-day mortality. We could not recognise any factor related to ARE bacteraemia or E. faecalis 30-day mortality.

CONCLUSION

History of hospitalisation and invasive device use were related to VRE bacteraemia. APACHE II and history of chemotherapy were predictors of mortality. We could not identify factors related to ARE or predictors of mortality.

摘要

目的

我们旨在确定与万古霉素耐药粪肠球菌(VRE)和氨苄西林耐药屎肠球菌(ARE)菌血症相关的危险因素,预测 30 天死亡率,并根据耐药性预测 90 天无复发生存率。

方法

我们评估了 2007 年至 2017 年期间患有屎肠球菌和粪肠球菌菌血症的患者的临床记录。我们进行了二变量和多变量逻辑回归分析,以确定与 VRE 和 ARE 菌血症相关的因素以及 30 天死亡率的预测因素。使用 Kaplan-Meier 估计法进行了 90 天无复发生存率的评估。

结果

我们分别确定了 192 例和 147 例粪肠球菌和屎肠球菌菌血症发作,其中 55.7%的粪肠球菌为 VRE(94%为 vanA),12.2%的屎肠球菌为 ARE。与 VRE 菌血症相关的因素包括既往住院(aOR,80.18,95%CI 1.81-634)、中心静脉导管史(aOR,11.15,95%CI 2.48-50.2)和气管插管使用史(aOR,17.91,95%CI 1.22-262.82)。VRE(28%,95%CI 14-68%;P<0.001)和 ARE(10%,95%CI 0.1-36%;P=0.58)菌血症的归因死亡率明显高于其敏感株。APACHE II(aOR,1.45,95%CI 1.26-1.66)和化疗史(aOR,3.52,95%CI 1.09-11.39)是粪肠球菌菌血症 30 天死亡率的预测因素。我们无法识别与 ARE 菌血症或屎肠球菌 30 天死亡率相关的任何因素。

结论

既往住院和侵袭性器械使用与 VRE 菌血症有关。APACHE II 和化疗史是死亡率的预测因素。我们无法确定与 ARE 相关的因素或死亡率的预测因素。

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