Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E-faecium
Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E-faecium
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DOI：
10.1093/clinids/22.4.663
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发表时间：
1996-04-01
影响因子：
11.8
通讯作者：
Kusne, S
中科院分区：
文献类型：
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作者：
Linden, PK;Pasculle, AW;Kusne, S
为了确定万古霉素耐药菌引起的肠球菌菌血症病例的结果差异，我们将连续接受肝移植服务、因耐万古霉素屎肠球菌 (VREF) (n = 54) 出现临床显着菌血症的患者与同期患有万古霉素敏感屎肠球菌的患者进行比较。 (VSEF) 菌血症 (n = 48)。 VREF 菌血症的住院时间明显晚于 VSEF 菌血症（分别为 43 天和 24 天；P < .01）；此外，与 VSEF（56% 的患者）相比，VREF 更频繁地成为分离出的唯一血液病原体（占 56% 的患者）（P = .0002），VREF 队列比 VSEF 队列更频繁地需要对腹内和胸腔内感染进行侵入性干预（分别为 45 名患者中的 34 名和 41 名患者中的 20 名；P = .01），万古霉素耐药 更频繁地导致复发性菌血症（54 名感染 VREF 的患者中的 22 名 vs 48 名感染 VSEF 的患者中的 7 名；P = .006）、原发部位肠球菌属持续分离（33 名感染 VREF 的患者中的 27 名 vs 18 名感染 VSEF 的患者中的 7 名；P = .005）和血管内感染（4 名感染 VREF 的患者 vs 没有感染 VSEF 的患者）。 VSEF）。从最后一次菌血症发作开始测量，VREF 队列中患者生存率下降幅度更大 (P = .02)，万古霉素耐药、休克和肝功能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较高，部分原因是缺乏有效的抗菌治疗。
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.