肠球菌属血流感染92例临床及病原菌特点分析

Clinical and microbiological characteristics of 92 cases of enterococcal bloodstream infection

目的研究粪肠球菌和屎肠球菌血流感染(BSI)的临床特点、细菌耐药性及感染易患因素。方法回顾性分析四川省人民医院2011年1月—2013年11月确诊的成人粪肠球菌和屎肠球菌BSI临床和病原学资料。结果 92例患者中分离出粪肠球菌21例,屎肠球菌71例;其中社区获得性感染25例,医院感染67例。粪肠球菌BSI患者的主要基础疾病为尿毒症(42.9%)、心脏病(23.8%)、肺部疾病(19.0%)和神经系统疾病(19.0%);屎肠球菌BSI患者的主要基础疾病为肝、胆、胰腺疾病,各种肿瘤和肺部疾病,分别占40.8%;主要易感因素包括中心静脉置管(73.2%)、30 d内手术史(62.0%)、年龄65岁以上(52.1%)、入住重症监护病房(ICU)(32.4%)和有创机械通气(26.8%)。粪肠球菌对氨苄西林和万古霉素敏感率为100%,对青霉素敏感率为95.2%,对利奈唑胺敏感率90.4%;屎肠球菌对利奈唑胺和万古霉素敏感率分别为100%和96.9%,对氨苄西林、青霉素耐药率高于90%。年龄65岁以上、入住ICU、有创机械通气和罹患肿瘤是肠球菌属BSI患者在入院15 d内死亡的独立危险因素,48 h内合理抗菌药物应用是BSI患者15 d内免于死亡的保护因素;基础疾病为肝、胆、胰腺疾病患者病死率较低。结论肠球菌属BSI以屎肠球菌为主,屎肠球菌耐药率明显高于粪肠球菌;年龄65岁以上、入住ICU、有创机械通气和罹患肿瘤是肠球菌属BSI患者入院15 d内死亡的独立危险因素,48 h内使用有效抗菌药物可降低病死率。

Objective To evaluate the clinical, microbiological and epidemiological characteristics of enterococcal bloodstream injections （BSIs）. Methods Microbiological and clinical data were retrospectively collected and reviewed For the adult patients with enterococcal BSI who were treated in Sichuan Provincial People＇s Hospital from January 1, 2011 to November 30, 2013. Results Of the 92 cases of enterococcal BSIs,21 were due to E. faecalis and 71 were caused by E. faecium, respectively. The BSI was hospital acquired in 67 cases. The other were community acquired BSI. E. faecalis BSIs were complicated with uremia （42.9%）, heart disease （23. 8%）, pulmonary infection （19. 0%） and central neurological disorder （19.0%）, while E. faecium BSls were complicated with hepatobiliary and pancreatic diseases （40.8 5%）, neoplastic disease（40.8% ） and pulmonary infection （40. 8% ）. Risk factors for E. faecium acquisition were mainly central venous catheter （73.2 %）, recent surgey within 30 days （62.0%）, elderly patients （52.1%）, ICU admission （32.4%） and invasive mechanical ventilation （26.8%）. Strains of E. faecalis were 100% susceptible to ampicillin and vancomycin, 90. 4% to linezolid. Strains of E. faecium were 100% susceptible to linezolid, 96. 9% to vancomycin, and approximately 90% resistant to ampicillin and penicillin. Logistic regression analysis showed that the independent risk factors for 15 day crude mortality due patients, admission to ICU, to enterococcal BSI were elderly invasive mechanical ventilation and neoplastic disease. Adequate empirical antibiotic therapy within 48 hours was the protective factor of 15-day mortality rate. Patients with hepatobiliary and pancreatic diseases had lower mortality rate than other patients. Conclusions E. faeciurn is responsible for majority of the enteroeoccal BSIs. E. faecium strains have higher resistance rate to most antimicrobial agents tested than E. fecalis. Elderly patients, ICU admission, invasive mechanical ventilation and neoplastic diseases are the independent risk factors of 15-day mortality. Adequate antimierobial therapy within 48 hours can decrease the mortality rate effectively.