Infectious Disease Unit, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.
Department of Medical and Surgical Science, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
J Glob Antimicrob Resist. 2022 Jun;29:386-389. doi: 10.1016/j.jgar.2022.05.003. Epub 2022 May 13.
Conditions favouring persistent enterococcal bacteraemia (p-EB) have not been fully investigated yet. The aim of our study is to analyse risk factors for p-EB and its impact on mortality.
International two-centre retrospective study of all hospitalised adults with enterococcal bacteraemia managed with follow-up blood cultures (BCs) during the period 2011-2019. Exclusion criteria were: (1) death within 72 hours from index BCs and (2) polymicrobial bacteraemia. Primary endpoint was p-EB, defined as further isolation of the same species of Enterococcus spp. from BCs after at least 72 hours of appropriate antibiotic therapy. Multivariable logistic regression model was performed to assess risk factors for p-EB. The impact of p-EB on 30-day mortality was assessed by Kaplan-Meier survival curve and Cox regression multivariable model.
During the study period, 244 enterococcal bacteraemia were diagnosed. P-EB were 13.5% (33/244). At multivariable analysis, factors independently associated with p-EB were hematologic malignancy (OR 4.60 [95% CI 1.32-16.00], P = 0.01), infective endocarditis (OR 7.99 [95% CI 2.20-28.9], P = 0.002), and use of daptomycin as initial treatment (OR 4.50 [95% CI 1.29-15.61], P = 0.018). Mortality rate was higher in the p-EB group (32% vs. 18%). Kaplan-Meier survival curve showed that patients with p-EB were less likely to survive at 30 days from index BCs (log-rank P = 0.002). Using a Cox regression model, independent predictors of 30-day mortality were hematologic malignancy (HR 2.30 [95% CI 1.02-4.11], P = 0.043), p-EB (HR 1.93 [95% CI 0.92-4.04], P = 0.08), and septic shock (HR 5.92 [95% CI 2.17-16.30], P = 0.001).
P-EB was diagnosed mainly in very fragile patients and in those receiving daptomycin as frontline therapy. P-EB may have an impact on mortality.
有利于肠球菌持续性菌血症（p-EB）的条件尚未得到充分研究。本研究的目的是分析 p-EB 的危险因素及其对死亡率的影响。
对 2011 年至 2019 年期间接受治疗并进行后续血培养（BC）监测的所有住院成人肠球菌菌血症患者进行国际双中心回顾性研究。排除标准为：（1）从初次 BC 开始 72 小时内死亡；（2）混合微生物菌血症。主要终点是 p-EB，定义为在适当的抗生素治疗至少 72 小时后，从 BC 中进一步分离出相同种属的肠球菌属。采用多变量逻辑回归模型评估 p-EB 的危险因素。Kaplan-Meier 生存曲线和 Cox 回归多变量模型评估 p-EB 对 30 天死亡率的影响。
在研究期间，共诊断出 244 例肠球菌菌血症。p-EB 占 13.5%（33/244）。多变量分析显示，与 p-EB 独立相关的因素是血液恶性肿瘤（OR 4.60 [95% CI 1.32-16.00]，P=0.01）、感染性心内膜炎（OR 7.99 [95% CI 2.20-28.9]，P=0.002）和初始使用达托霉素治疗（OR 4.50 [95% CI 1.29-15.61]，P=0.018）。p-EB 组的死亡率更高（32% vs. 18%）。Kaplan-Meier 生存曲线显示，从初次 BC 开始 30 天内，p-EB 患者的存活可能性较低（对数秩 P=0.002）。使用 Cox 回归模型，30 天死亡率的独立预测因素是血液恶性肿瘤（HR 2.30 [95% CI 1.02-4.11]，P=0.043）、p-EB（HR 1.93 [95% CI 0.92-4.04]，P=0.08）和感染性休克（HR 5.92 [95% CI 2.17-16.30]，P=0.001）。
p-EB 主要发生在非常脆弱的患者和接受达托霉素作为一线治疗的患者中。p-EB 可能对死亡率有影响。
