Axell-House Dierdre B, Ashley Patrycja A, Egge Stephanie L, Tran Truc T, Pedroza Claudia, Zhang Meng, Dinh An Q, Simar Shelby R, Sahasrabhojane Pranoti V, Miller William R, Shelburne Samuel A, Hanson Blake M, Arias Cesar A
Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA.
Open Forum Infect Dis. 2024 May 17;11(6):ofae288. doi: 10.1093/ofid/ofae288. eCollection 2024 Jun.
Non- non- (NFF) enterococci are a heterogeneous group of clinically pathogenic enterococci that include species with intrinsic low-level vancomycin resistance. Patients with cancer are at increased risk for bacteremia with NFF enterococci, but their clinical and molecular epidemiology have not been extensively described.
We conducted a retrospective review of all patients (n = 70) with NFF bacteremia from 2016 to 2022 at a major cancer center. The main outcomes assessed were 30-day mortality, microbiological failure (positive blood cultures for ≥4 days), and recurrence of bacteremia (positive blood culture <14 days after clearance). Whole-genome sequencing was performed on all available NFF (n = 65).
Patients with hematological malignancies made up 56% of the cohort (77% had leukemia). The majority of solid malignancies (87%) were gastrointestinal in origin. The majority of infections (83%) originated from an intra-abdominal source. The most common NFF species were (50%) and (30%). Most (61%) patients received combination therapy. Bacteremia recurred in 4.3% of patients, there was a 30-day mortality of 23%, and 4.3% had microbiological failure. and isolates were genetically diverse with no spatiotemporal clustering to suggest a single strain. Frequencies of ampicillin resistance (4.3%) and daptomycin resistance (1.9%) were low. Patients with hematologic malignancy had infections with NFF enterococci that harbored more resistance genes than patients with solid malignancy ( = .005).
NFF bacteremia is caused by a heterogeneous population of isolates and is associated with significant mortality. Hematological malignancy is an important risk factor for infection with NFF resistant to multiple antibiotics.
非粪肠球菌（NFF）是一组临床致病性肠球菌，包括具有内在低水平万古霉素耐药性的菌种。癌症患者发生NFF肠球菌菌血症的风险增加，但其临床和分子流行病学尚未得到广泛描述。
我们对一家大型癌症中心2016年至2022年期间所有发生NFF菌血症的患者（n = 70）进行了回顾性研究。评估的主要结局包括30天死亡率、微生物学治疗失败（血培养阳性≥4天）和菌血症复发（清除后血培养阳性<14天）。对所有可用的NFF菌株（n = 65）进行了全基因组测序。
血液系统恶性肿瘤患者占队列的56%（77%患有白血病）。大多数实体恶性肿瘤（87%）起源于胃肠道。大多数感染（83%）源于腹腔内。最常见的NFF菌种是[具体菌种1]（50%）和[具体菌种2]（30%）。大多数（61%）患者接受了联合治疗。4.3%的患者菌血症复发，30天死亡率为23%，4.3%的患者出现微生物学治疗失败。[具体菌种1]和[具体菌种2]菌株在基因上具有多样性，没有时空聚集现象表明存在单一菌株。氨苄西林耐药率（4.3%）和达托霉素耐药率（1.9%）较低。血液系统恶性肿瘤患者感染的NFF肠球菌携带的耐药基因比实体恶性肿瘤患者更多（P = .005）。
NFF菌血症由多种菌株引起，且与显著的死亡率相关。血液系统恶性肿瘤是感染对多种抗生素耐药的NFF的重要危险因素。
