Noskin G A, Peterson L R, Warren J R
Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Clin Infect Dis. 1995 Feb;20(2):296-301. doi: 10.1093/clinids/20.2.296.
The incidence of enterococcal bacteremia due to Enterococcus faecium is increasing. To understand the clinical significance of E. faecium bacteremia, we compared 16 patients who were bacteremic due to E. faecium to 56 patients who were bacteremic due to Enterococcus faecalis. E. faecium bacteremia developed most frequently in severely ill patients with fever or hypothermia accompanied by CNS, cardiovascular, and/or pulmonary dysfunction, while E. faecalis bacteremia occurred most often in less seriously ill patients. Nosocomial acquisition, cancer, neutropenia, renal insufficiency, current corticosteroid therapy, and previous treatment with broad-spectrum antibiotics were significantly more frequently associated with E. faecium bacteremia. Mortality was significantly higher among patients infected with E. faecium than among those infected with E. faecalis (50% vs. 11%; P = .001); this was true particularly among patients with monomicrobial or nosocomial bacteremia, those who had previously received antibiotic treatment, and those with cancer. Death due to enterococcal bacteremia was observed only among severely ill patients. These findings suggest that E. faecium often infects debilitated patients and that such infection appears to be a significant factor contributing to mortality.
由粪肠球菌引起的肠球菌血症的发病率正在上升。为了解粪肠球菌血症的临床意义，我们将16例因粪肠球菌发生菌血症的患者与56例因粪肠球菌发生菌血症的患者进行了比较。粪肠球菌血症最常发生在患有发热或体温过低并伴有中枢神经系统、心血管和/或肺功能障碍的重症患者中，而粪肠球菌血症最常发生在病情较轻的患者中。医院获得性感染、癌症、中性粒细胞减少、肾功能不全、当前使用皮质类固醇治疗以及先前使用广谱抗生素治疗与粪肠球菌血症的相关性明显更高。感染粪肠球菌的患者的死亡率明显高于感染粪肠球菌的患者（50%对11%；P = 0.001）；在单微生物或医院获得性菌血症患者、先前接受过抗生素治疗的患者以及癌症患者中尤其如此。仅在重症患者中观察到因肠球菌血症导致的死亡。这些发现表明，粪肠球菌经常感染虚弱的患者，并且这种感染似乎是导致死亡率的一个重要因素。
