肠球菌属血流感染157例临床分析

A clinical analysis of 157 patients with Enterococcus bloodstream infection

目的分析肠球菌属血流感染的临床特点。方法回顾性分析157例肠球菌属血流感染患者的基础疾病、药敏结果、血培养时的体温、血常规、深静脉置管、治疗和转归。结果 157例患者中,粪肠球菌77例(49.0%),屎肠球菌76例(48.4%),鹑鸡肠球菌、鸟肠球菌各2例(1.3%)。157例患者均有至少1项基础疾病,多数为恶性实体瘤、肺部感染、恶性血液病。发热134例(85.4%),白细胞减少25例(15.9%),中性粒细胞减少19例(12.1%)(其中粒细胞缺乏症患者16例)。出现了对万古霉素、利奈唑胺和替考拉宁耐药的菌株,分别为13、11和7株。粪肠球菌对除四环素、利奈唑胺和庆大霉素外的大部分抗菌药物的耐药性都小于屎肠球菌。43例患者在血培养前有深静脉导管置入的侵入性操作。所有病例采用相应抗菌药物治疗,主要为万古霉素、利奈唑胺和替考拉宁,好转100例(63.7%)。结论基础疾病、深静脉置管和粒细胞缺乏是引起肠球菌属血流感染的危险因素,发热是其常见症状和预警信号。万古霉素、利奈唑胺和替考拉宁是治疗的主要药物,但应重视出现了对三者耐药的菌株。

Objective To analyze the clinical features of Enterococcus bloodstream infection . Methods The underlying diseases ,antibacterial susceptibility ,temperature at blood sampling ,results of routine blood tests ,venous catheterization ,therapy and prognosis of 157 patients with Enterococcus bloodstream infection were retrospectively analyzed .Results Of 157 cases ,77 cases （49.0% ） were due to Enterococcus faecalis ,76 cases（48.4% ） were due to Enterococcus faecium ,2 cases（1.3% ） were caused by Enterococcus gallinarum and 2 cases were caused by Enterococcus avium ,repectively . The mainly underlying diseases were malignant solid tumor ,pulmonary infection and hematological malignancies .One hundred and thirty-four patients （85.4% ） appeared fever ,25 patients （15.9% ） appeared leukopenia ,and 19 patients （12.1% ） appeared granulocytopenia ,of whom 16 patients appeared agranulocytosis .Vancomysin ,linezolid and teicoplanin-resistant stains were 13 ,11 and 7 , respectively .The resistance rate of Enterococcus f aecium was higer than Enterococcus f aecalis to the most antimicrobials except for tetracycline ,linezolid and high-dose gentamicin .Forty-three patients had venous catheterization before blood culture .Most patients received vancomycin ,linezolid or teicoplanin therapy and 100 patients （63.7% ） were improved .Conclusion Immunocompromise and impairment of mucosal barrier function caused by underlying diseases ,venous catheterization and agranulocytosis are the risk factors for Enterococcus bloodstream infection .Fever is one of the common symptoms and warning signals .Vancomycin ,linezolid and teicoplanin are the main antibiotics ,but attention should be paid to the occurrence of antibiotic-resistant bacteria against the antibiotics mentioned above .