Stosor V, Peterson L R, Postelnick M, Noskin G A
Department of Medicine, Northwestern University Medical School, Chicago, Ill 60611, USA.
Arch Intern Med. 1998 Mar 9;158(5):522-7. doi: 10.1001/archinte.158.5.522.
Enterococcus faecium has received increased attention, primarily due to the emergence of vancomycin resistance. The purpose of this investigation was to study the epidemiological characteristics of vancomycin-resistant E faecium (VRE) bacteremia and to determine the clinical impact of vancomycin resistance on the outcome of patients with this infection.
We retrospectively analyzed the clinical features and outcome of 53 patients with E faecium bacteremia.
From January 1992 until December 1995, there were 32 episodes of bacteremia caused by vancomycin-susceptible E faecium (VSE) and 21 caused by VRE. An intra-abdominal site was the most common source of bacteremia in both groups. All of the VRE and 78% of VSE bacteremia cases were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (P<.001), as were indwelling bladder catheters (P=.01). Fifty-nine percent of the patients with VSE bacteremia survived vs 24% with VRE (P=.009), despite similar severity-of-illness scores. In 62% of the patients with VRE sepsis, death was related to the bacteremia (P=.01). Patients infected with VRE had longer hospitalizations than those with VSE (34.8 vs 16.7 days, respectively) (P=.004), were more likely to be on the medical service (P=.03), and on the average, had hospitalization costs of more than $27,000 per episode than did patients with VSE bloodstream infection ($83,897 vs $56,707, respectively) (P=.04).
Vancomycin-resistant E faecium bacteremia is a complication of prolonged hospitalization in debilitated patients. Vancomycin resistance has a negative impact on survival in patients with E faecium bacteremia and leads to higher health care costs.
粪肠球菌受到越来越多的关注，主要是由于万古霉素耐药性的出现。本研究的目的是探讨耐万古霉素粪肠球菌（VRE）菌血症的流行病学特征，并确定万古霉素耐药性对该感染患者预后的临床影响。
我们回顾性分析了53例粪肠球菌菌血症患者的临床特征和预后。
从1992年1月至1995年12月，有32例由万古霉素敏感粪肠球菌（VSE）引起的菌血症发作，21例由VRE引起。腹腔内部位是两组菌血症最常见的来源。所有VRE菌血症和78%的VSE菌血症病例均为医院获得性。先前使用万古霉素与VRE菌血症相关（P<0.001），留置膀胱导管也与之相关（P=0.01）。尽管疾病严重程度评分相似，但VSE菌血症患者的生存率为59%，而VRE菌血症患者为24%（P=0.009）。在62%的VRE败血症患者中，死亡与菌血症有关（P=0.01）。感染VRE的患者住院时间比感染VSE的患者长（分别为34.8天和16.７天）（P=0.004），更有可能在内科治疗（P=0.03），并且平均每次发作的住院费用比VSE血流感染患者多超过27,000美元（分别为83,897美元和56,707美元）（P=0.04）。
耐万古霉素粪肠球菌菌血症是虚弱患者长期住院的并发症。万古霉素耐药性对粪肠球菌菌血症患者的生存有负面影响，并导致更高的医疗费用。
