Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia.
Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia.
复制标题
DOI：
10.1093/ofid/ofy107
复制
发表时间：
2018-06
影响因子：
4.2
通讯作者：
Sung AD
中科院分区：
文献类型：
--
作者：
Messina JA;Sinha R;Starr K;Arshad M;Alexander BD;Chao NJ;Sung AD
在接受化疗的急性白血病（AL）患者中，复发性肠球菌血流感染（R-EBSI）的发生率和风险因素以及是否有相同的遗传谱系导致指数EBSI和R-EBSI尚不清楚。纳入了2010年至2015年92例EBSI AL患者。肠球菌血流感染定义为31例屎肠球菌或粪肠球菌血培养阳性，伴发热、低血压或寒战。通过末次阳性培养和退热后324小时的31次阴性培养来定义清除。复发性肠球菌血流感染的定义为肠球菌清除后324小时血培养阳性。分类变量报告为比例，并通过χ2检验进行比较。通过中位数和四分位距（IQR）总结连续变量，并通过Wilcoxon-Mann-Whitney检验进行比较。P值<0.05被认为是显著的。对来自7名患者的可用配对BSI分离株进行全基因组测序。24例患者（26%）发生了31次R-EBSI。至R-EBSI（IQR）的中位时间为26（13-50）天。R-EBSI患者在其指数EBSI期间的发热和甲硝唑暴露持续时间明显较长。39%的E.屎肠球菌R-EBSI分离株在达托霉素治疗指数EBSI后变为达托霉素不敏感肠球菌（DNSE）。全基因组测序分析证实4/7例患者的索引EBSI和R-EBSI分离株的遗传相关性概率较高。复发性肠球菌血流感染和DNSE在AL患者中很常见，往往发生在EBSI指数的前30天内。发热持续时间和甲硝唑暴露可能有助于确定R-EBSI的风险。全基因组测序分析表明，同一菌株在某些患者中引起EBSI和R-EBSI。
Rates and risk factors for recurrent enterococcal bloodstream infection (R-EBSI) and whether the same genetic lineage causes index EBSI and R-EBSI are unknown in patients with acute leukemia (AL) receiving chemotherapy. Ninety-two AL patients with EBSI from 2010 to 2015 were included. Enterococcal bloodstream infection was defined by 31 positive blood cultures for Enterococcus faecium or Enterococcus faecalis and fever, hypotension, or chills. Clearance was defined by 31 negative cultures 324 hours after last positive culture and defervescence. Recurrent enterococcal bloodstream infection was defined by a positive blood culture for Enterococcus 324 hours after clearance. Categorical variables were reported as proportions and compared by the χ2 test. Continuous variables were summarized by median and interquartile range (IQR) and compared by the Wilcoxon-Mann-Whitney Test. P values <.05 were considered significant. Whole-genome sequencing was performed on available paired BSI isolates from 7 patients. Twenty-four patients (26%) had 31 episodes of R-EBSI. Median time to R-EBSI (IQR) was 26 (13–50) days. Patients with R-EBSI had significantly longer durations of fever and metronidazole exposure during their index EBSI. Thirty-nine percent of E. faecium R-EBSI isolates became daptomycin-nonsusceptible Enterococcus (DNSE) following daptomycin therapy for index EBSI. Whole-genome sequencing analysis confirmed high probability of genetic relatedness of index EBSI and R-EBSI isolates for 4/7 patients. Recurrent enterococcal bloodstream infection and DNSE are common in patients with AL and tend to occur within the first 30 days of index EBSI. Duration of fever and metronidazole exposure may be useful in determining risk for R-EBSI. Whole-genome sequencing analysis demonstrates that the same strain causes both EBSI and R-EBSI in some patients.
登录
查看更多内容
影响因子：
3.7
作者：
Cheah AL;Peel T;Howden BP;Spelman D;Grayson ML;Nation RL;Kong DC
通讯作者：
Kong DC
影响因子：
3.7
作者：
Walker BJ;Abeel T;Shea T;Priest M;Abouelliel A;Sakthikumar S;Cuomo CA;Zeng Q;Wortman J;Young SK;Earl AM
通讯作者：
Earl AM
影响因子：
2.6
作者：
Ornstein, Moshe C.;Mukherjee, Sudipto;Sekeres, Mikkael A.
通讯作者：
Sekeres, Mikkael A.
影响因子：
20.3
作者：
Taur, Ying;Jenq, Robert R.;Pamer, Eric G.
通讯作者：
Pamer, Eric G.
影响因子：
1.7
作者：
Bankevich, Anton;Nurk, Sergey;Pevzner, Pavel A.
通讯作者：
Pevzner, Pavel A.