Department of Internal Medicine, Busan Medical Center, Busan, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
BMC Infect Dis. 2024 Sep 2;24(1):906. doi: 10.1186/s12879-024-09824-w.
Glycopeptides for ampicillin-susceptible Enterococcus faecalis/faecium bacteremia are readily prescribed depending on the severity of the condition. However, there is limited data on the outcomes of glycopeptide use compared to ampicillin-containing regimens for ampicillin-susceptible E. faecalis/faecium bacteremia. From an antibiotic stewardship perspective, it is important to determine whether the use of glycopeptides is associated with improved clinical outcomes in patients with ampicillin-susceptible E. faecalis/faecium bacteremia.
This retrospective cohort study was conducted at a university-affiliated hospital between January 2010 and September 2019. We collected data from patients with positive blood cultures for Enterococcus species isolates. The clinical data of patients who received ampicillin-containing regimens or glycopeptides as definitive therapy for ampicillin-susceptible E. faecalis/faecium bacteremia were reviewed. Multivariate logistic regression analysis was performed to identify risk factors for 28-day mortality.
Ampicillin-susceptible E. faecalis/faecium accounted for 41.2% (557/1,353) of enterococcal bacteremia cases during the study period. A total of 127 patients who received ampicillin-containing regimens (N = 56) or glycopeptides (N = 71) as definitive therapy were included in the analysis. The 28-day mortality rate was higher in patients treated with glycopeptides (19.7%) than in those treated with ampicillin-containing regimens (3.6%) (p = 0.006). However, in the multivariate model, antibiotic choice was not an independent predictor of 28-day mortality (adjusted OR, 3.7; 95% CI, 0.6-23.6).
Glycopeptide use was not associated with improved mortality in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. This study provides insights to reduce the inappropriate use of glycopeptides in ampicillin-susceptible E. faecalis/faecium bacteremia treatment and promote antimicrobial stewardship.
对于氨苄西林敏感的粪肠球菌/屎肠球菌菌血症，根据病情严重程度，可方便地开处方使用糖肽类药物。然而，与含氨苄西林的方案相比，关于糖肽类药物治疗氨苄西林敏感的粪肠球菌/屎肠球菌菌血症的结果数据有限。从抗生素管理的角度来看，确定糖肽类药物的使用是否与氨苄西林敏感的粪肠球菌/屎肠球菌菌血症患者的临床转归改善相关，这一点很重要。
本回顾性队列研究于 2010 年 1 月至 2019 年 9 月在一所大学附属医院进行。我们从血培养阳性的肠球菌属分离株患者中收集数据。对接受含氨苄西林方案或糖肽类药物作为氨苄西林敏感的粪肠球菌/屎肠球菌菌血症确定性治疗的患者的临床数据进行了回顾。采用多变量逻辑回归分析确定 28 天死亡率的危险因素。
在研究期间，氨苄西林敏感的粪肠球菌/屎肠球菌占肠球菌菌血症病例的 41.2%（557/1,353）。共有 127 名患者接受了含氨苄西林方案（N=56）或糖肽类药物（N=71）作为确定性治疗，纳入了分析。接受糖肽类药物治疗的患者（19.7%）的 28 天死亡率高于接受含氨苄西林方案治疗的患者（3.6%）（p=0.006）。然而，在多变量模型中，抗生素选择不是 28 天死亡率的独立预测因素（调整后的 OR，3.7；95%CI，0.6-23.6）。
在氨苄西林敏感的粪肠球菌/屎肠球菌菌血症患者中，糖肽类药物的使用并未改善死亡率。本研究为减少氨苄西林敏感的粪肠球菌/屎肠球菌菌血症治疗中糖肽类药物的不当使用以及促进抗菌药物管理提供了见解。
