Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy.
UGC Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarenagrid.411375.5, Sevilla, Spain.
Microbiol Spectr. 2022 Aug 31;10(4):e0005122. doi: 10.1128/spectrum.00051-22. Epub 2022 Jun 30.
Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ≤ 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score.
胆道血流感染（BT-BSI）由屎肠球菌和粪肠球菌引起，与经验性治疗不当和预后较差有关，而其他病因则不然。本研究旨在探讨肠球菌 BT-BSI 的危险因素。从 PROBAC 队列中选择了胆道血流感染的患者，包括 2016 年 10 月至 2017 年 3 月期间 26 家西班牙医院的连续菌血症患者，比较了由屎肠球菌、粪肠球菌和其他原因引起的感染。采用逻辑回归分析确定肠球菌的独立预测因素，并建立预测评分。共纳入 850 例胆道血流感染患者，其中 73 例（8.5%）为目标菌感染，包括 48 例（66%）粪肠球菌和 25 例（34%）屎肠球菌。多变量分析表明，与肠球菌相关的独立变量为（比值比；95%置信区间）：胆管癌（4.48；1.32 至 15.25）、医院获得性感染（3.58；2.11 至 6.07）、前一个月使用碳青霉烯类药物（3.35；1.45 至 7.78）、胆道支架（2.19；1.24 至 3.90）和中重度慢性肾脏病（1.55；1.07 至 2.26）。该模型的 AUC 为 0.74[95%CI0.67 至 0.80]。建立了一个评分系统，将这些变量分别记为 7、6、5、4 和 2 分，评分≤6 时阴性预测值为 95%。包括胆管癌、胆道支架、医院获得性感染、碳青霉烯类药物使用史和慢性肾脏病的模型对肠球菌性胆道血流感染具有中等预测能力。尽管该评分仍需验证，但在怀疑胆道感染合并菌血症时，该信息可能有助于决定经验性治疗。胆道感染较为常见，是发病率和死亡率的重要原因。这些感染中常见菌血症，尤其是老年人和癌症患者。经验性治疗不当与菌血症性胆管炎的死亡率增加有关，而由肠球菌引起的感染接受无效经验性治疗的可能性更高。这是因为指南中推荐的许多用于胆道感染的抗菌药物对这些病原体缺乏活性。据我们所知，这是第一项分析肠球菌性胆道血流感染预测因素并得出预测评分的研究。
