Dr. Ziauddin University Hospital, North Nazimabad, Karachi, Pakistan.
Isra University Hospital, Hyderabad, Pakistan.
BMC Infect Dis. 2023 Aug 6;23(1):514. doi: 10.1186/s12879-023-08498-0.
Enterococcal bacteremia has become prevalent in the recent decade, especially in hospitalized patients. Moreover, the rise in resistance patterns against antibiotic drugs regarding enterococci infection, such as cephalosporins, ampicillin and vancomycin, is prevailing. The major driving force behind this is the incongruous use of antibiotics with a minor contribution from environmental stressors which calls for vigilant and prudent administration of evidence-based antibiotics.
A retrospective study was conducted from January 1 2017 until December 31 2021, at the tertiary care center, Dr Ziauddin Hospital in Karachi, Pakistan.
Our research revealed ampicillin resistance in 87 (63.5%), with an estimated 25 (18.8%) mortality. Male gender 19 (76%) and vancomycin resistance 13 (52%) were associated with increased mortality. Furthermore, appropriate antibiotic therapy reduced the risk of death compared with inappropriate and excessive use of antibiotics 10 (40%) vs. 15 (60%) vs. 20 (80%) respectively. Targeted therapy with amoxicillin/clavulanic acid was associated with lower mortality 1 (4%) and higher discharge rates 34 (32.1%). On Kaplan-Meier survival, targeted therapy with amoxicillin/clavulanic acid was associated with shorter hospital stays and prolonged survival. UTI was found as the most common source of enterococcal bacteremia 57 (41.6%), followed by respiratory 21 (15.3%) and intra-abdominal 13 (9.5%). In 26 (19%) patients, no identifiable source of infection was found.
Vancomycin resistance and male gender were found independent risk factors for mortality. The use of inappropriate antibiotics significantly increases mortality in these patients. The appropriate antibiotic therapy reduces the risk of death. Furthermore, overuse of antibiotics didn't reduce mortality; instead increased the financial burden and chances of developing multi-drug resistant strains of other organisms by increasing hospital stays of patients.
肠球菌菌血症在最近十年变得普遍，尤其是在住院患者中。此外，肠球菌感染对抗生素药物（如头孢菌素、氨苄西林和万古霉素）的耐药模式上升，这一现象普遍存在。造成这种情况的主要原因是抗生素的使用不当，环境压力因素的影响较小，因此需要谨慎使用基于证据的抗生素。
本研究是一项回顾性研究，于 2017 年 1 月 1 日至 2021 年 12 月 31 日在巴基斯坦卡拉奇的齐亚uddin 医院进行。
我们的研究显示，氨苄西林耐药率为 87（63.5%），估计死亡率为 25（18.8%）。男性（76%）和万古霉素耐药（52%）与死亡率增加相关。此外，与抗生素使用不当和过量相比，适当的抗生素治疗降低了死亡风险，分别为 10（40%）、15（60%）和 20（80%）。与阿莫西林/克拉维酸靶向治疗相关的死亡率较低，为 1（4%），出院率较高，为 34（32.1%）。在 Kaplan-Meier 生存分析中，阿莫西林/克拉维酸靶向治疗与住院时间缩短和生存时间延长相关。尿路感染是肠球菌菌血症最常见的来源，57（41.6%），其次是呼吸道感染 21（15.3%）和腹腔内感染 13（9.5%）。在 26（19%）患者中，未发现感染的明确来源。
万古霉素耐药和男性是死亡的独立危险因素。这些患者使用不适当的抗生素会显著增加死亡率。适当的抗生素治疗可降低死亡风险。此外，抗生素使用不当不会降低死亡率，反而会增加患者的住院时间，增加医疗费用，并增加其他病原体产生多药耐药株的机会。
