Clinical and microbiological features of bacteremia caused by Enterococcus faecalis
Clinical and microbiological features of bacteremia caused by Enterococcus faecalis
复制标题
DOI：
10.3855/jidc.6587
复制
发表时间：
2015-11-01
影响因子：
1.9
通讯作者：
Baldaccini, Beatriz
中科院分区：
文献类型：
--
作者：
Ceci, Monica;Delpech, Gaston;Baldaccini, Beatriz
简介：粪肠球菌是住院患者侵袭性感染的常见病原体。本研究的目的是分析粪肠球菌引起的菌血症的临床和微生物学特征。方法：对2011年至2013年间住院患者由粪肠球菌引起的显着菌血症进行研究。记录患者特征、合并症和 14 天死亡率。毒力基因 esp、gelE 和 cylA；调理吞噬抵抗；对正常血清的杀菌作用有抵抗力； β-内酰胺酶的产生；结果：从33例菌血症患者体内回收粪肠球菌菌株。 2 名患者被诊断为多种微生物菌血症； 10名患者死亡。在死亡患者和幸存者的菌株中都发现了毒力基因。菌血症的来源包括尿路感染（36.4%）、血管导管（15.1%）、脓肿（9.1%）和不明原因（48.5%）。基础疾病包括癌症（30.3%）、糖尿病（36.4%）、肝硬化（6.1%）、肾病（36.4%）和慢性阻塞性肺病（2.0%）。合并症包括饮酒（26.1%）；糖皮质激素治疗（19.0%）；既往接受过抗生素治疗（60.6%）；以及中心静脉（21.2%）、动脉（12.1%）和导尿管（63.6%）。此外，57.6%的患者来自重症监护室（ICU）； 33.3% 接受机械通气。与死亡相关的重要病症包括多种微生物菌血症、肿瘤疾病、APACHE II 评分 >= 20、ICU 住院、肾脏疾病、中心静脉导管和机械通气。结论：患者的结果与其状态相关，而不与粪肠球菌菌株中毒力基因的存在相关。相当大比例的菌血症来源不明。通过易位，另一个来源可能是胃肠道。
Introduction: Enterococcus faecalis is a frequent etiologic agent of invasive infections in hospitalized patients. The aim of this study was to analyze clinical and microbiological features of bacteremia caused by E. faecalis.Methodology: Between 2011 and 2013, significant bacteremia caused by E. faecalis in hospitalized patients was studied. Patient characteristics, comorbid conditions, and 14-day mortality were recorded. Virulence genes esp, gelE, and cylA; opsonophagocytosis resistance; resistance to bactericidal effect of normal serum; beta lactamase production; and susceptibility to ampicillin, vancomycin, teicoplanin, gentamicin, and streptomycin were investigated.Results: E. faecalis strains were recovered from 33 bacteremic patients. Polymicrobial bacteremia was diagnosed in 2 patients; 10 patients died. Virulence genes were found in strains from both deceased patients and survivors. Sources of bacteremia included urinary tract infections (36.4%), vascular catheters (15.1%), abscesses (9.1%), and unknown (48.5%). Underlying diseases included cancer (30.3%), diabetes (36.4%), cirrhosis (6.1%), renal (36.4%), and chronic obstructive pulmonary disease (2.0%). Co-morbidities included alcohol use (26.1%); glucocorticoid therapy (19.0%); prior antibiotic therapy (60.6%); and central venous (21.2%), arterial (12.1%), and urinary (63.6%) catheters. Also, 57.6% of patients came from the intensive care unit (ICU); 33.3% had mechanical ventilation. Significant mortality-associated conditions included polymicrobial bacteremia, oncological disease, APACHE II score >= 20, ICU stay, renal disease, central venous catheter, and mechanical ventilation.Conclusions: Outcome of patients was associated with their status and not with the presence of virulence genes in E. faecalis strains. A significant percentage of bacteremia had undetermined origin. An alternate origin may be the gastrointestinal tract, through translocation.