替考拉宁治疗粪肠球菌血流感染的疗效：全国性监测的事后分析。

Efficacy of teicoplanin in bloodstream infections caused by Enterococcus faecium: posthoc analysis of a nationwide surveillance.

机构信息

Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.

出版信息

Int J Infect Dis. 2022 Sep;122:506-513. doi: 10.1016/j.ijid.2022.06.029. Epub 2022 Jun 23.

DOI:10.1016/j.ijid.2022.06.029

PMID:35752376

Abstract

OBJECTIVES

Vancomycin and teicoplanin are glycopeptides with activity against Enterococcus faecium. However, studies on the clinical efficacy of teicoplanin are limited. This study aimed to compare the therapeutic efficacy of teicoplanin and vancomycin in E. faecium bacteremia.

METHODS

We identified patients with bloodstream infections prospectively from July 2015 to December 2016 in 14 hospitals as part of a multicenter nationwide surveillance. Patients with E. faecium monomicrobial bacteremia were selected. Teicoplanin and vancomycin groups included patients treated with either agent for ≥48 hours. The primary outcome was 30-day all-cause in-hospital mortality. The Cox proportional hazards model with inverse probability weighting was used to account for the imbalance in baseline characteristics between the two groups.

RESULTS

Among 97 patients with E. faecium bacteremia, 33 (34%) were treated with teicoplanin and 64 (66%) with vancomycin. There were no significant differences in 30-day in-hospital mortality (18.2% vs 26.6%, P = 0.358) and 7-day mortality (6.1% vs 15.6%, P = 0.212). Furthermore, multivariable analysis confirmed that the use of teicoplanin was not significantly associated with mortality (adjusted odds ratio, 0.72; 95% confidence interval, 0.28-1.86; P = 0.494).

CONCLUSION

We found no significant differences in the clinical outcomes. These findings suggest teicoplanin as a useful alternative to vancomycin.

摘要

目的

万古霉素和替考拉宁是具有抗粪肠球菌活性的糖肽类抗生素。然而，替考拉宁的临床疗效研究有限。本研究旨在比较替考拉宁与万古霉素治疗粪肠球菌菌血症的疗效。

方法

我们从 2015 年 7 月至 2016 年 12 月在 14 家医院前瞻性地识别血流感染患者，作为全国多中心监测的一部分。选择粪肠球菌单一微生物菌血症患者。替考拉宁和万古霉素组包括接受≥48 小时上述药物治疗的患者。主要结局为 30 天全因院内死亡率。采用逆概率加权的 Cox 比例风险模型来校正两组间基线特征的不平衡。

结果

在 97 例粪肠球菌菌血症患者中，33 例（34%）接受替考拉宁治疗，64 例（66%）接受万古霉素治疗。30 天院内死亡率（18.2% vs. 26.6%，P=0.358）和 7 天死亡率（6.1% vs. 15.6%，P=0.212）无显著差异。此外，多变量分析证实，使用替考拉宁与死亡率无显著相关性（调整比值比，0.72；95%置信区间，0.28-1.86；P=0.494）。