Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study.
Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study.
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DOI：
10.1186/s12879-015-1175-6
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发表时间：
2015-10-16
影响因子：
3.7
通讯作者：
Kohno S
中科院分区：
文献类型：
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作者：
Kajihara T;Nakamura S;Iwanaga N;Oshima K;Takazono T;Miyazaki T;Izumikawa K;Yanagihara K;Kohno N;Kohno S
肠球菌属是医院感染的特别重要的病原体。然而，临床环境中肠球菌感染的临床特征和危险因素知之甚少。该样本包括肠球菌属患者。2010年至2011年期间从长崎大学医院的临床样本中检测到的感染和肠球菌定植患者（对照患者）。在这项回顾性研究中，肠球菌感染的危险因素进行了分析，通过比较感染和对照患者，通过多变量logistic回归。共纳入182例感染患者（平均年龄64.6 ± 18.2岁; 114例男性）和358例对照患者（肠球菌定植患者）（平均年龄61.6 ± 22.4岁; 183例男性）。肠球菌感染分为腹膜内（n = 87）、尿路（n = 28）或血流（n = 20）感染。癌症和恶性血液病是肠球菌感染中最常见的合并症。碳青霉烯和万古霉素分别用于43.8%和57.9%的粪肠球菌和屎肠球菌感染患者。未分离出万古霉素耐药肠球菌。多变量分析确定腹部手术（比值比[OR]，2.233; 95%置信区间[CI]，1.529-3.261; p ≤ 0.001），尿路结构异常（OR，2.086; 95% CI，1.088-4.000; p = 0.027），男性（OR，1.504; 95% CI，1.032-2.190; p = 0.033）和低白蛋白血症（OR，0.731; 95% CI，0.555-0.963; p = 0.026）作为肠球菌感染的独立危险因素。多因素分析显示腹部手术（OR，2.263; 95% CI，1.464-3.498; p ≤ 0.001），尿路结构异常（OR，2.634; 95% CI，1.194-5.362; p = 0.008）和低白蛋白血症（OR，0.668; 95% CI，0.490-0.911; p = 0.011）是E.粪便感染最后，免疫抑制剂使用（OR，3.837; 95% CI，1.397-10.541; p = 0.009）和原位器械使用（OR，3.807; 95% CI，1.180-12.276; p = 0.025）是E.粪便感染这些发现可能有助于早期启动抗菌药物，以提高临床成功率。
Enterococcus spp. are particularly important etiological agents of nosocomial infections. However, the clinical characteristics of and risk factors for enterococcal infections in clinical settings are poorly understood. The sample included patients with Enterococcus spp. infections detected from clinical samples at Nagasaki University Hospital between 2010 and 2011 and patients with enterococcal colonization (control patients). In this retrospective study, the risk factors for enterococcal infections were analyzed by comparing infected and control patients via multivariate logistic regression. A total of 182 infected (mean age, 64.6 ± 18.2 years; 114 men) and 358 control patients (patients with enterococcal colonization) (mean age, 61.6 ± 22.4 years; 183 men) were included. Enterococcal infections were classified as intraperitoneal (n = 87), urinary tract (n = 28), or bloodstream (n = 20) infections. Cancer and hematological malignancies were the most common comorbidities in enterococcal infections. Carbapenem and vancomycin were administered to 43.8 % and 57.9 % of patients infected with Enterococcus faecalis and Enterococcus faecium, respectively. No vancomycin-resistant enterococci were isolated. Multivariate analysis identified abdominal surgery (odds ratio [OR], 2.233; 95 % confidence interval [CI], 1.529–3.261; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.086; 95 % CI, 1.088–4.000; p = 0.027), male sex (OR, 1.504; 95 % CI, 1.032–2.190; p = 0.033), and hypoalbuminemia (OR, 0.731; 95 % CI, 0.555–0.963; p = 0.026) as independent risk factors for enterococcal infections. Multivariate analysis showed abdominal surgery (OR, 2.263; 95 % CI, 1.464–3.498; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.634; 95 % CI, 1.194–5.362; p = 0.008), and hypoalbuminemia (OR, 0.668; 95 % CI, 0.490–0.911; p = 0.011) were independent risk factors for E. faecalis infection. Finally, immunosuppressive agent use (OR, 3.837; 95 % CI, 1.397–10.541; p = 0.009) and in situ device use (OR, 3.807; 95 % CI, 1.180–12.276; p = 0.025) were independent risk factors for E. faecium infection. These findings might inform early initiation of antimicrobial agents to improve clinical success.