Linden P K, Pasculle A W, Manez R, Kramer D J, Fung J J, Pinna A D, Kusne S
Department of Anesthesiology, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Clin Infect Dis. 1996 Apr;22(4):663-70. doi: 10.1093/clinids/22.4.663.
To determine the differences in outcome in cases of enterococcal bacteremia due to vancomycin-resistant organisms, we compared consecutive patients on a liver transplant service who had clinically significant bacteremia due to vancomycin-resistant Enterococcus faecium (VREF) (n = 54) with a contemporaneous cohort of patients who had vancomycin-susceptible E. faecium (VSEF) bacteremia (n = 48). VREF bacteremia occurred significantly later in the hospitalization than did VSEF bacteremia (43 days vs. 24 days, respectively; P < .01); in addition, VREF was more frequently the sole blood pathogen isolated (91% of patients) than was VSEF (56% of patients) (P = .0002). Invasive interventions for intraabdominal and intrathoracic infection were required more often in the VREF cohort than in the VSEF cohort (34 of 45 patients vs. 20 of 41 patients, respectively; P = .01). Vancomycin resistance more frequently resulted in recurrent bacteremia (22 of 54 patients infected with VREF vs. 7 of 48 patients infected with VSEF; P = .006), persistent isolation of Enterococcus species at the primary site (27 of 33 patients infected with VREF vs. 7 of 18 patients infected with VSEF; P = .005), and endovascular infection (4 patients infected with VREF vs. none infected with VSEF). The decrement in patient survival, as measured from the last bacteremic episode, was greater in the VREF cohort (P = .02). Vancomycin resistance, shock, and liver failure were independent risk factors for Enterococcus-associated mortality. Higher rates of refractory infection, serious morbidity, and attributable death occurred in the VREF cohort and were partially mediated by the lack of effective antimicrobial therapy.
为了确定耐万古霉素的肠球菌引起的肠球菌血症患者的预后差异，我们比较了肝移植病房中因耐万古霉素粪肠球菌（VREF）导致临床显著菌血症的连续患者（n = 54）和同期因对万古霉素敏感的粪肠球菌（VSEF）菌血症的患者队列（n = 48）。VREF菌血症在住院期间出现的时间明显晚于VSEF菌血症（分别为43天和24天；P < 0.01）；此外，VREF更常是唯一分离出的血液病原体（91%的患者），而VSEF为（56%的患者）（P = 0.0002）。VREF队列比VSEF队列更常需要对腹腔和胸腔感染进行侵入性干预（分别为45例患者中的34例 vs. 41例患者中的20例；P = 0.01）。万古霉素耐药更常导致复发性菌血症（54例感染VREF的患者中有22例 vs. 48例感染VSEF的患者中有7例；P = 0.006）、在原发部位持续分离出肠球菌属（33例感染VREF的患者中有27例 vs. 18例感染VSEF的患者中有7例；P = 0.005）以及血管内感染（4例感染VREF的患者 vs. 无感染VSEF的患者）。从最后一次菌血症发作开始测量，VREF队列患者的生存下降幅度更大（P = 0.02）。万古霉素耐药、休克和肝衰竭是肠球菌相关死亡的独立危险因素。VREF队列中难治性感染、严重发病率和可归因死亡的发生率更高，部分原因是缺乏有效的抗菌治疗。
