Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections
Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections
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DOI：
10.1016/j.jgar.2015.12.002
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发表时间：
2016-06-01
影响因子：
4.6
通讯作者：
Potter, Emily M.
中科院分区：
文献类型：
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作者：
Britt, Nicholas S.;Potter, Emily M.
本研究旨在评价由鸡肠球菌或粪黄肠球菌引起的万古霉素耐药肠球菌血流感染（VRE BSI）的临床结局。确定与治疗失败相关的变量，并比较治疗方案。这是一项针对非粪便、非粪便VRE BSI住院退伍军人事务部患者的国家回顾性研究。主要结局为治疗失败，定义为以下各项的复合终点：（i）30天全因死亡率;（ii）微生物失效;和（iii）30天VRE BSI复发。进行逐步泊松回归以确定与治疗失败相关的变量。共纳入48例患者，其中29例（60.4%）由E. 19例（39.6%）由E.石蒜黄在这些病例中，20例（41.7%）接受抗VRE药物（利奈唑胺或达托霉素）治疗，28例（58.3%）接受抗肠球菌β-内酰胺治疗。总体而言，30天死亡率为10.4%（5/48），复合治疗失败率为39.6%（19/48）。在多变量分析中，与抗VRE治疗相比，抗肠球菌β-内酰胺治疗与治疗失败增加相关（校正风险比= 1.73，95%置信区间1.06-4.97; P = 0.031）。总体而言，利奈唑胺或达托霉素治疗万古霉素耐药E。gallinarum或E.与抗肠球菌β-内酰胺治疗相比，casseliflavus BSI导致改善的临床结果。由Elsevier Ltd代表国际感染和癌症化疗学会发表。
This study aimed to evaluate the clinical outcomes of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) caused by Enterococcus gallinarum or Enterococcus casseliflavus. Variables associated with treatment failure were determined and treatment options were compared. This was a national retrospective study of hospitalised Veterans Affairs patients with non-faecium, non-faecalis VRE BSI. The primary outcome was treatment failure, defined as a composite of: (i) 30-day all-cause mortality; (ii) microbiological failure; and (iii) 30-day VRE BSI recurrence. Stepwise Poisson regression was conducted to determine variables associated with treatment failure. In total, 48 patients were included, with 29 cases (60.4%) caused by E. gallinarum and 19 cases (39.6%) caused by E. casseliflavus. Among these cases, 20 (41.7%) were treated with an anti-VRE agent (linezolid or daptomycin) and 28 (58.3%) were treated with an anti-enterococcal beta-lactam. Overall, 30-day mortality was 10.4% (5/48) and composite treatment failure was 39.6% (19/48). In multivariable analysis, treatment with an anti-enterococcal beta-lactam was associated with increased treatment failure in comparison with anti-VRE therapy (adjusted risk ratio = 1.73, 95% confidence interval 1.06-4.97; P = 0.031). Overall, treatment with linezolid or daptomycin for vancomycin-resistant E. gallinarum or E. casseliflavus BSI resulted in improved clinical outcomes in comparison with anti-enterococcal beta-lactam treatment. Published by Elsevier Ltd on behalf of International Society for Chemotherapy of Infection and Cancer.