VANCOMYCIN-RESISTANT ENTEROCOCCUS-FAECIUM BACTEREMIA - RISK-FACTORS FOR INFECTION
VANCOMYCIN-RESISTANT ENTEROCOCCUS-FAECIUM BACTEREMIA - RISK-FACTORS FOR INFECTION
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DOI：
10.1093/clinids/20.5.1126
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发表时间：
1995-05-01
影响因子：
11.8
通讯作者：
WENZEL, RP
中科院分区：
文献类型：
--
作者：
EDMOND, MB;OBER, JF;WENZEL, RP
我们描述了一个爆发万古霉素耐药屎肠球菌（vanA表型）菌血症的三级护理社区医院的肿瘤病房。在ii例患者中，有10例患者在菌血症时患有白血病和中性粒细胞减少（中性粒细胞减少的中位持续时间为21天）。在发生万古霉素耐药粪肠杆菌血症之前，患者平均接受6种抗生素治疗共61天。22株分离株的分子分型显示，大多数（83%）是一种常见菌株，表明存在院内传播。将这11例患者与22例对照患者进行比较，发现耐万古霉素粪肠杆菌胃肠道定植（比值比[0]无穷大，P = 0.005）和使用对厌氧菌有显著活性的抗菌药物（甲硝唑、克林霉素、亚胺培南；比值比无穷大，P = 0.02）是发生耐万古霉素粪肠杆菌血症的危险因素。由于目前尚无针对这种感染的有效治疗方法，因此迫切需要确定有效的措施来预防和控制耐万古霉素的粪肠杆菌血症的发展。
We describe an outbreak of vancomycin-resistant Enterococcus faecium (vanA phenotype) bacteremia on the oncology ward of a tertiary care community hospital. In 10 of the ii cases the patients had leukemia and were neutropenic (median duration of neutropenia, 21 days) at the time of bacteremia. On average, patients received six antibiotic agents for a total of 61 agent-days prior to development of vancomycin-resistant E. faecium bacteremia. The mortality rate was 73%, Molecular typing of 22 isolates revealed that the majority (83%) represented a common strain, indicating nosocomial spread. When the 11 cases were compared to 22 matched control patients, gastrointestinal colonization with vancomycin-resistant E. faecium (odds ratio [denominator, 0] infinity, P = .005) and the use of antimicrobial agents with significant activity against anaerobes (metronidazole, clindamycin, and imipenem; odds ratio infinity, P = .02) were found to be risk factors for the development of vancomycin-resistant E. faecium bacteremia. Since no proven therapy for such infection exists, there is an urgent need to identify effective measures to prevent and control the development of vancomycin-resistant E. faecium bacteremia.