BACTEREMIA CAUSED BY HEMOLYTIC, HIGH-LEVEL GENTAMICIN-RESISTANT ENTEROCOCCUS-FAECALIS
BACTEREMIA CAUSED BY HEMOLYTIC, HIGH-LEVEL GENTAMICIN-RESISTANT ENTEROCOCCUS-FAECALIS
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DOI：
10.1128/aac.35.8.1626
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发表时间：
1991-08-01
影响因子：
4.9
通讯作者：
GILMORE, MS
中科院分区：
文献类型：
--
作者：
HUYCKE, MM;SPIEGEL, CA;GILMORE, MS
1984年1月1日至1987年12月31日期间，对威斯康星大学医院和诊所的206株肠球菌血液分离株进行了高水平氨基糖苷耐药性（此后高水平氨基糖苷耐药性简单地称为“耐药性”）和溶血素产生的分析。190株粪肠球菌中有68株（35.8%）对庆大霉素耐药。68株菌株中，67株（98.5%）含有编码双功能氨基糖苷修饰6′-氨基糖苷乙酰转移酶-2′-氨基糖苷磷酸转移酶[AAC（6′）-APH（2′）]酶的基因。在190株分离株中，85株（44.7%）具有溶血性，含有肠局部溶血素成分a的基因编码。68株庆大霉素耐药菌株中有62株（91.2%）溶血，122株庆大霉素敏感菌株中仅有23株（18.8%）溶血（P < 0.001）。12株溶血性、庆大霉素耐药的粪肠球菌血液分离株，但9株非溶血性或庆大霉素敏感的分离株中只有2株具有相同的染色体DNA限制性内切酶酶切模式，表明这些菌株具有共同的来源。一项1985年7月1日至1987年3月31日的历史队列研究通过回归分析确定了术后重症监护病房状态（优势比[OR]， 5.0； 95%可信区间[CI]， 1.1至22.8）和既往使用广谱或广谱头孢菌素治疗（OR, 3.0; 95% CI， 0.9至10.1）为耐庆大霉素粪肠球菌菌血症的危险因素。与非溶血性庆大霉素敏感菌株患者相比，溶血性庆大霉素耐药粪肠杆菌菌血症患者在菌血症后3周内死亡的风险增加了5倍（95% CI， 1.0至25.4）。
Between 1 January 1984 and 31 December 1987, 206 enterococcal blood isolates at the University of Wisconsin Hospital and Clinics were analyzed for high-level aminoglycoside resistance (hereafter high-level aminoglycoside resistance is simple referred to as "resistance") and hemolysin production. Of 190 Enterococcus faecalis isolates, 68 (35.8%) were resistant to gentamicin. Of these 68 strains, 67 (98.5%) contained a gene coding for the bifunctional aminoglycoside-modifying 6'-aminoglycoside acetyltransferase-2"-aminoglycoside phosphotransferase [AAC(6')-APH(2")] enzyme. Of 190 isolates, 85 (44.7%) were hemolytic and contained a gene coding for component A of the enteroccal hemolysin. Sixty-two of 68 (91.2%) gentamicin-resistant isolates but only 23 of 122 (18.8%) gentamicin-susceptible isolates were hemolytic (P < 0.001). Twelve of the hemolytic, gentamicin-resistant E. faecalis blood isolates, but only 2 of 9 nonhemolytic or gentamicin-susceptible isolates, had identical chromosomal DNA restriction endonuclease digestion patterns, suggesting a common derivation for these strains. A historical cohort study from 1 July 1985 to 31 March 1987 identified by regression analysis postsurgical intensive care unit status (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.1 to 22.8) and prior treatment with an expanded- or broad-spectrum cephalosporin (OR, 3.0; 95% CI, 0.9 to 10.1) as risk factors for gentamicin-resistant E. faecalis bacteremia. Patients with hemolytic, gentamicin-resistant E. faecalis bacteremia had a fivefold-increased risk for death within 3 weeks of their bacteremia compared with patients with nonhemolytic, gentamicin-susceptible strains (95% CI, 1.0 to 25.4).