Rinaldi Matteo, Rancan Ilaria, Malerba Federica, Gatti Milo, Ancillotti Leonardo, Tazza Beatrice, Campoli Caterina, Bonazzetti Cecilia, Profiti Beatrice, Caroccia Natascia, Ambretti Simone, Tumbarello Mario, Viale Pierluigi, Giannella Maddalena
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Department for Integrated Risk Management, Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
J Antimicrob Chemother. 2025 Aug 1;80(8):2247-2256. doi: 10.1093/jac/dkaf197.
Optimal management of Enterococcus faecium bloodstream infection (BSI) is not fully understood.
Multicentre retrospective observational study of all consecutive adult (≥18 years old) patients with E. faecium BSI, between January 2016 and December 2023, at two tertiary teaching hospitals in northern Italy. Patients who died within 48 h from BSI onset were excluded. Primary and secondary endpoints were 30 day mortality and persistent E. faecium BSI, respectively. Cox regression and logistic binary analyses were used.
Overall, 391 patients were enrolled: median age was 72 (IQR 61-81) years, 225 were male (57.5%), median Charlson comorbidity index (CCI) was 6 (IQR 4-8) and 94 had immunosuppression (24.0%). BSIs were primary, secondary and device-related in 25.1%, 36.2% and 38.7%, respectively. Vancomycin resistance was found in 30.3%. The appropriate empirical therapy rate was given for 29.1%. All-cause 30 day mortality was 34.3% and the rate of persistent BSI was 18.8%. Variables independently associated with 30 day mortality were immunosuppression (HR 1.638, 95% CI 1.022-2.625, P = 0.040), SOFA (HR 1.205, 95% CI 1.144-1.268, P < 0.001), primary BSI (HR 1.839, 95% CI 1.221-2.770, P = 0.004), source control (HR 0.534, 95% CI 0.260-0.972, P = 0.042) and the performance of follow-up blood cultures (HR 0.403, 95% CI 0.280-0.972, P < 0.001). Factors independently associated with persistent E. faecium BSI were: CCI (OR 1.157, 95% CI 1.030-1.300, P = 0.014), source control not performed (OR 3.275, 95% CI 1.113-9.635, P = 0.031) and teicoplanin (OR 2.023, 95% CI 1.018-4.018, P = 0.044).
Among modifiable clinical factors in patients with E. faecium BSI, source control and the execution of follow-up blood cultures demonstrated a protective effect on 30 day mortality. Teicoplanin as targeted antibiotic treatment was independently associated with persistent BSI.
粪肠球菌血流感染（BSI）的最佳管理尚未完全明确。
对2016年1月至2023年12月期间意大利北部两家三级教学医院所有连续的成年（≥18岁）粪肠球菌BSI患者进行多中心回顾性观察研究。排除BSI发病后48小时内死亡的患者。主要和次要终点分别为30天死亡率和持续性粪肠球菌BSI。采用Cox回归和逻辑二元分析。
共纳入391例患者：中位年龄为72（四分位间距61 - 81）岁，男性225例（57.5%），中位Charlson合并症指数（CCI）为6（四分位间距4 - 8），94例有免疫抑制（24.0%）。BSI分别为原发性、继发性和与器械相关的占25.1%、36.2%和38.7%。发现万古霉素耐药率为30.3%。给予适当经验性治疗的比例为29.1%。全因30天死亡率为34.3%，持续性BSI发生率为18.8%。与30天死亡率独立相关的变量有免疫抑制（风险比1.638，95%置信区间1.022 - 2.625，P = 0.040）、序贯器官衰竭评估（SOFA）（风险比1.205，95%置信区间1.144 - 1.268，P < 0.001）、原发性BSI（风险比1.839，95%置信区间1.221 - 2.770，P = 0.00）、源头控制（风险比0.534，95%置信区间0.260 - 0.972，P = 0.042）以及进行随访血培养（风险比0.403，95%置信区间0.280 - 0.972，P < 0.001）。与持续性粪肠球菌BSI独立相关的因素有：CCI（比值比1.157，95%置信区间1.030 - 1.300，P = 0.014）、未进行源头控制（比值比3.275，95%置信区间1.113 - 9.635，P = 0.031）和替考拉宁（比值比2.023，95%置信区间1.018 - 4.018，P = 0.044）。
在粪肠球菌BSI患者中可改变的临床因素中，源头控制和进行随访血培养对30天死亡率有保护作用。替考拉宁作为靶向抗生素治疗与持续性BSI独立相关。
