Burnett R J, Haverstock D C, Dellinger E P, Reinhart H H, Bohnen J M, Rotstein O D, Vogel S B, Solomkin J S
Department of Surgery, University of Cincinnati College of Medicine, Ohio, USA.
Surgery. 1995 Oct;118(4):716-21; discussion 721-3. doi: 10.1016/s0039-6060(05)80040-6.
The role of enterococcus in intraabdominal infection is controversial. This study examines the contribution of enterococcus to adverse outcome in a large intraabdominal infection trial.
A randomized prospective double-blind trial was performed to compare two different antimicrobial regimens in combination with surgical or percutaneous drainage in the treatment of complicated intraabdominal infections. A total of 330 valid patients was enrolled from 22 centers in North America.
In 330 valid patients, 71 had enterococcus isolated from the initial drainage of an intraabdominal focus of infection. This finding was associated with a significantly higher treatment failure rate than that of patients without enterococcus (28% versus 14%, p < 0.01). In addition, only Acute Physiology and Chronic Health Evaluation II score and presence of enterococcus were significant independent predictors of treatment failure when stepwise logistic regression was performed (p < 0.01 and < 0.03). Risk factors for the presence of enterococcus include age, Acute Physiology and Chronic Health Evaluation II, preinfection hospital length of stay, postoperative infections, and anatomic source of infection. There was no difference between the clinical trial treatment regimens with regard to overall failure, failure associated with enterococcus, or frequency of enterococcal isolation.
This study is the first to report enterococcus as a predictor of treatment failure in complicated intraabdominal infections. This trial also identifies several significant risk factors for the presence of enterococcus in such infections.
肠球菌在腹腔内感染中的作用存在争议。本研究在一项大型腹腔内感染试验中探讨了肠球菌对不良结局的影响。
进行了一项随机前瞻性双盲试验，比较两种不同抗菌方案联合手术或经皮引流治疗复杂性腹腔内感染的效果。从北美22个中心共纳入330例有效患者。
在330例有效患者中，71例患者腹腔内感染初始引流物中分离出肠球菌。这一发现与无肠球菌患者相比，治疗失败率显著更高（28%对14%，p<0.01）。此外，进行逐步逻辑回归分析时，只有急性生理与慢性健康状况评分II以及肠球菌的存在是治疗失败的显著独立预测因素（p<0.01和<0.03）。肠球菌存在的危险因素包括年龄、急性生理与慢性健康状况评分II、感染前住院时间、术后感染以及感染的解剖学来源。在总体失败、与肠球菌相关的失败或肠球菌分离频率方面，临床试验治疗方案之间没有差异。
本研究首次报道肠球菌是复杂性腹腔内感染治疗失败的预测因素。该试验还确定了此类感染中肠球菌存在的几个重要危险因素。
