Watanakunakorn C, Patel R
Department of Internal Medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio.
Clin Infect Dis. 1993 Jul;17(1):74-8. doi: 10.1093/clinids/17.1.74.
Patients with enterococcal bacteremia due to strains with and without high-level gentamicin resistance (HLGR; MIC, > 2,000 mg/L) were compared. Between 1986 and 1991, there were 178 episodes of enterococcal bacteremia: 47 and 131 episodes, respectively, due to enterococcal strains with and without HLGR. Sixty-two, 57, and 59 episodes, respectively, were in patients with transient bacteremia (a single positive blood culture), bacteremia (two or more positive blood cultures), and polymicrobial bacteremia. Nosocomial bacteremia accounted for 61.7% and 51.1% of episodes due to strains with and without HLGR, respectively. All isolates were strains of Enterococcus faecalis except for 13 strains of Enterococcus faecium, 4 of Enterococcus avium, and 3 of Enterococcus durans. Although the mortality was slightly higher among patients infected with strains with HLGR than among those infected with strains without HLGR (38.3% vs. 30.5%, respectively), there was no statistical difference. The mortality rate was adversely affected by old age (P < .01) and rapidly and ultimately fatal underlying conditions (P < .001). The addition of gentamicin to the treatment regimens had no effect on mortality.
对因高水平庆大霉素耐药（HLGR；MIC，>2000mg/L）菌株和非高水平庆大霉素耐药菌株引起的肠球菌血症患者进行了比较。1986年至1991年间，共发生178例肠球菌血症：分别有47例和131例是由高水平庆大霉素耐药菌株和非高水平庆大霉素耐药菌株引起的。分别有62例、57例和59例发生在短暂菌血症（单次血培养阳性）、菌血症（两次或更多次血培养阳性）和多微生物菌血症患者中。医院获得性菌血症分别占高水平庆大霉素耐药菌株和非高水平庆大霉素耐药菌株所致病例的61.7%和51.1%。除13株粪肠球菌、4株鸟肠球菌和3株耐久肠球菌外，所有分离株均为粪肠球菌。虽然感染高水平庆大霉素耐药菌株的患者死亡率略高于感染非高水平庆大霉素耐药菌株的患者（分别为38.3%和30.5%），但无统计学差异。死亡率受到老年（P<.01）以及迅速且最终致命的基础疾病（P<.001）的不利影响。在治疗方案中添加庆大霉素对死亡率没有影响。
