Sivasubramanian Barath Prashanth, Antony Raj Ajay Sriram, Ravikumar Diviya Bharathi, Ravanam Aneela Satya, Patel Rutvi Balkrishna, Mudumalagurthy Samhitha, Kotharu Devi Meghana, Zeeshan Mohd, Chavan Manisha, Patel Jay, Vala Akhila, Tirupathi Raghavendra, Dalal Rutul, Shekar Saketh Palasamudram
Internal Medicine, Northeast Georgia Medical Centre, Gainesville, GA, USA.
Institute of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India.
Infez Med. 2025 Mar 1;33(1):114-124. doi: 10.53854/liim-3301-11. eCollection 2025.
Enterococci are the third most common cause of healthcare-associated infections in the United States, affecting 10-12% of all transplant recipients worldwide. Enterococcal bacteremia complicates the post-transplant recovery and raises mortality to 18%. This study aims to identify factors linked to mortality in hematopoietic stem cell transplant (HSCT) recipients with Enterococcus infection.
We conducted a retrospective analysis using the National Inpatient Sample Database (2018-2021). Adults treated with HSCT and admitted for Enterococcus infection were identified using ICD-10 codes. The analysis utilized descriptive statistics and multivariate regression, with significance at a p-value ≤0.05.
A total of 40,462 HSCT patients, 1.3% were admitted with Enterococcus infection. The crude mortality rate was higher in the Enterococcus cohort than in the non-Enterococcus cohort (10.4% vs. 4.6%); however, the mortality risk was substantially lower in the Enterococcus cohort (p<0.001). In the Enterococcus cohort, patients with fungal infections, sepsis, acute respiratory failure, and those with invasive ventilation had a high mortality risk (p<0.05). In leukemia patients treated with HSCT, the Enterococcus cohort had higher mortality than the non-Enterococcus cohort (12.5% vs. 5.0%; aOR 1.8, 95% CI 1.9-2.6, p=0.005).
In HSCT recipients, Enterococcus infection is a clinical marker for poor prognosis. Early broad-spectrum antibiotic therapy is essential for patients with sepsis, respiratory compromise, and fungal co-infections. Additionally, a multidisciplinary team is crucial for managing respiratory and renal failure.
肠球菌是美国医疗保健相关感染的第三大常见病因，影响全球所有移植受者的10%-12%。肠球菌血症会使移植后的恢复复杂化，并将死亡率提高到18%。本研究旨在确定与造血干细胞移植（HSCT）受者感染肠球菌后的死亡率相关的因素。
我们使用国家住院样本数据库（2018-2021年）进行了一项回顾性分析。使用ICD-10编码识别接受HSCT治疗并因感染肠球菌而入院的成年人。该分析采用描述性统计和多变量回归，p值≤0.05具有统计学意义。
共有40462例HSCT患者，1.3%因感染肠球菌入院。肠球菌队列的粗死亡率高于非肠球菌队列（10.4%对4.6%）；然而，肠球菌队列的死亡风险显著较低（p<0.001）。在肠球菌队列中，合并真菌感染、脓毒症、急性呼吸衰竭以及接受有创通气的患者死亡风险较高（p<0.05）。在接受HSCT治疗的白血病患者中，肠球菌队列的死亡率高于非肠球菌队列（12.5%对5.0%；调整后比值比1.8，95%置信区间1.9-2.6，p=0.005）。
在HSCT受者中，肠球菌感染是预后不良的临床指标。对于合并脓毒症、呼吸功能不全和真菌合并感染的患者，早期广谱抗生素治疗至关重要。此外，多学科团队对于管理呼吸和肾衰竭至关重要。
