Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1 place de l'hôpital, 67000 Strasbourg, France; INSERM, UMR_S1260, Regenerative Nanomedicine (RNM), CRBS, Centre de Recherche en Biomédecine de Strasbourg, Université de Strasbourg, 1 rue Eugène Boeckel, 67000 Strasbourg, France.
Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, 67000 Strasbourg, France.
Int J Infect Dis. 2023 Oct;135:45-48. doi: 10.1016/j.ijid.2023.07.014. Epub 2023 Jul 28.
Staphylococcus epidermidis (SE) is a supposedly low-virulence agent, which may cause proven bloodstream infections (BSIs), with little-known consequences on intensive care unit (ICU) patients. We aimed at studying ICU patients diagnosed with BSIs caused by SE (SE-BSIs).
We constituted a retrospective cohort in two medical ICUs. SE-BSIs were defined by two or more independent SE-positive blood cultures of the same strain, within 48 hours, without concurrent infection.
We included 59 patients; 58% were men (n = 34), with median age of 67 (interquartile range 60-74) years and a simplified acute physiology score II of 59 (36-74) points, and 56% were immunocompromised (n = 33). Among the 37 (63%) patients requiring norepinephrine initiation or increase at the onset of SE-BSI versus patients not requiring vasopressors (37%; n = 22), concomitant arterial lactate levels reached 2.8 (1.9-5.8) versus 1.5 (1.3-2.2) mmol/l (P <0.01), whereas the mean blood pressure was 49 (42-54) versus 61 (56-65) mm Hg (P = 0.01) and the mortality was 46% (n = 17) vs 14% (n = 3) at day 28 (P = 0.01), respectively. Regarding antibiotics, the susceptibility rates toward linezolid and vancomycin were 71% (n = 41/58) and 100% (n = 54/54), respectively. At the time of SE-BSI, all but one patient had a central venous access device.
This work highlights SE-BSIs as a cause of septic shock, mostly in immunocompromised ICU patients, with increasing concerns about resistance to antibiotics and central line management.
表皮葡萄球菌（SE）被认为是一种低毒力病原体，它可能导致已证实的血流感染（BSI），但其对重症监护病房（ICU）患者的影响鲜为人知。我们旨在研究诊断为表皮葡萄球菌引起的血流感染（SE-BSI）的 ICU 患者。
我们在两个医学 ICU 中组成了一个回顾性队列。SE-BSI 的定义是在 48 小时内，同一菌株的两份或多份独立的 SE 阳性血培养结果，且无同时感染。
我们纳入了 59 名患者；58%为男性（n=34），中位年龄为 67 岁（四分位距 60-74 岁），简化急性生理学评分 II 为 59 分（36-74 分），56%为免疫功能低下（n=33）。在 37 名（63%）需要开始或增加去甲肾上腺素治疗的 SE-BSI 患者与不需要血管加压药的患者（37%；n=22）相比，同时的动脉血乳酸水平分别达到 2.8（1.9-5.8）mmol/L 和 1.5（1.3-2.2）mmol/L（P<0.01），而平均血压分别为 49（42-54）mmHg 和 61（56-65）mmHg（P=0.01），第 28 天死亡率分别为 46%（n=17）和 14%（n=3）（P=0.01）。关于抗生素，利奈唑胺和万古霉素的敏感性率分别为 71%（n=41/58）和 100%（n=54/54）。在发生 SE-BSI 时，除 1 名患者外，所有患者均有中心静脉置管。
这项工作强调了 SE-BSI 是感染性休克的一个原因，主要发生在免疫功能低下的 ICU 患者中，并且对抗生素耐药性和中心静脉导管管理的担忧日益增加。
