Epidemiological, Microbiological, Clinical, and Prognostic Factors of Bacteremia Caused by High-Level Vancomycin-Resistant Enterococcus Species
Epidemiological, Microbiological, Clinical, and Prognostic Factors of Bacteremia Caused by High-Level Vancomycin-Resistant Enterococcus Species
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高水平耐万古霉素肠球菌引起的菌血症的流行病学、微生物学、临床和预后因素
DOI：
10.1007/s100960000360
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发表时间：
2000
影响因子：
4.5
通讯作者：
M. Gobernado
中科院分区：
文献类型：
--
作者：
V. Peset;P. Tallón;C. Sola;E. Sánchez;A. Sarrión;C. Pérez;A. Vindel;E. Cantón;M. Gobernado
摘要为了研究高水平万古霉素耐药肠球菌菌血症的流行病学、微生物学、临床和预后特征，在1994年至1996年进行了一项病例对照研究。 将17例因万古霉素耐药肠球菌（vanA基因型：16例粪肠球菌，1例屎肠球菌）导致临床显著菌血症的连续患者与169例万古霉素敏感肠球菌菌血症患者进行比较。通过多变量分析选择以下因素作为影响高水平万古霉素耐药肠球菌菌血症发展的独立风险因素：既往糖肽类药物治疗（P=0.049）;纳入血液透析计划（P=0.046）;既往皮质类固醇或抗真菌药物治疗（P=0.029）;既往手术治疗（P=0.022）。通过单变量分析选择了以下其他因素：气管切开术（P=0.002）;住院时间延长（P=0.01）;以及任何类型的穿刺（P=0.02）。粗相关死亡率为13.4%。17株肠球菌vanA基因扩增阳性。脉冲场凝胶电泳的基因组DNA后，SmaI消化的vanA菌株显示，一个菌株占主导地位（10株），但至少有四个类似的带型被确定（6株）。对16株与本次暴发密切相关的菌株进行了进一步调查。外科重症监护室是第一个也是参与最多的服务。vanA万古霉素耐药肠球菌菌血症的医院爆发发生在1994年和1995年之间，由粪肠球菌引起。据信，这是迄今为止在西班牙医院描述的第一次也是唯一一次此类疫情。
Abstract A case-control study was performed between 1994 and 1996 in order to study the epidemiological, microbiological, clinical, and prognostic features of high-level vancomycin-resistant enterococcal bacteremia. Seventeen consecutive patients who had clinically significant bacteremia due to vancomycin-resistant enterococci (vanA genotype: 16 Enterococcus faecalis, 1 Enterococcus faecium) were compared with 169 who had vancomycin-susceptible enterococcal bacteremia. The following were selected by multivariate analysis as independent risk factors that influenced the development of high-level vancomycin-resistant enterococcal bacteremia: prior glycopeptide therapy (P=0.049); inclusion in a hemodialysis program (P=0.046); prior therapy with corticosteroids or antineoplastic agents (P=0.029); and prior surgical treatment (P=0.022). The following other factors were selected by univariate analysis: tracheostomy (P=0.002); prolonged hospitalization (P=0.01); and any kind of puncture (P=0.02). The crude associated-mortality rate was 13.4%. Gene amplification of vanA was positive for 17 strains of enterococci. Pulsed-field gel electrophoresis of genomic DNA after SmaI digestion of vanA isolates revealed that one strain predominated (10 isolates), though at least four similar banding patterns were identified (6 isolates). The 16 strains closely related to the outbreak were investigated further. The surgical intensive care unit was the first and most involved service. The hospital outbreak of vanA vancomycin-resistant enterococcal bacteremia occurred between 1994 and 1995 and was caused by Enterococcus faecalis. This is believed to be the first and only such outbreak described in a Spanish hospital thus far.
影响因子：
11.8
作者：
EDMOND, MB;OBER, JF;WENZEL, RP
通讯作者：
WENZEL, RP