肠球菌血流感染50例临床研究  

Clinical study of 50 cases of enterococcal bloodstream infection

作　　者：侯喜琴[1] 马晓波[1] 林贵兰[1] 张轶[2] 李珣[1] 

机构地区：[1]厦门大学附属第一医院暨福建医科大学教学医院检验科,福建厦门361003 [2]厦门大学附属第一医院同民分院暨厦门市第五医院

出　　处：《中国感染与化疗杂志》2016年第4期394-397,共4页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81302529);福建省自然科学基金(2014D007)

摘　　要：目的分析肠球菌血流感染的临床特征及病原菌分布,为临床诊疗提供依据。方法回顾性分析2013年1月-2014年12月厦门某三甲医院的50例肠球菌血流感染患者资料。细菌鉴定和药敏试验采用法国生物梅里埃的VITEK2-Compact全自动微生物分析系统。药敏结果统计采用WHONET 5.6软件。结果 50例肠球菌血流感染患者中分离的病原菌包括26株粪肠球菌和24株屎肠球菌;患者基础疾病包括肿瘤17例、2型糖尿病5例、急性胆管炎3例等。易感因素包括导管留置29例、手术19例、低蛋白血症6例、粒细胞减少5例、入住ICU 7例、使用呼吸机5例。23例患者存在原发感染病灶,其中感染肠球菌例数/感染例数比56.5%(13/23):尿路感染6/7、手术部位感染4/4和胆道感染1/4等。粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替加环素全部敏感。粪肠球菌对青霉素和氨苄西林全部敏感,而屎肠球菌对奎奴普丁-达福普汀100%敏感。对高浓度氨基糖苷类敏感的粪肠球菌菌株分别为庆大霉素50.0%(13/26)、链霉素65.4%(17/26);屎肠球菌为庆大霉素25.0%(6/24)和链霉素62.5%(15/24)。46例在血培养结果回报前经验性使用了抗菌药物,41例经验抗菌治疗不合适(占89.1%)。32例患者根据药敏结果针对性的调整用药,17例好转,2例死亡。结论对于肠球菌血流感染,临床经验抗菌治疗常不合适,预后并不理想;粪肠球菌和屎肠球菌对抗菌药物的敏感性存在一定差异,及时根据药敏结果针对性抗菌治疗对感染的控制及患者的预后有着积极的意义。Objective The clinical data and pathogenic characteristics of enterococcal bloodstream infections were reviewed to provide evidence for appropriate clinical diagnosis and antimicrobial therapy. Methods The data of 50 cases of bloodstream infection caused by Enterococcus were collected from a tertiary hospital in Xiamen from January 2013 to December 2014. Identification and antimicrobial susceptibility testing of the bacterial isolates were performed by VITEK2-Compact automatic system. Antimicrobial susceptibility data were analyzed with WHONET 5.6 software. Results The pathogens of the 50 cases included 26 strains ofE. faecalis and 24 strains ofE. faecium. The underlying diseases were tumor （17 cases）, type 2 diabetes mellitus （5） and acute cholangitis （3）. Predisposing factors included indwelling catheter （29 cases）, surgery （19）, hypoproteinemia （6）, neutropenia （5）, ICU stay （7） and ventilator use （5）. Primary site of infection was identified in 23 patients, 56.5% （13 in 23 cases） of which weredue to Enterococcus, including urine （6 in 7 cases）, incision （4 in 4 cases）, or bile （1 in 4 cases）. All the enterococcal strains were sensitive to vancomycin, linezolid and tigecycline. All the E. faeealis isolates were sensitive to penicillin and ampicillin, while all the E. faecium isolates were sensitive to quinupristin- dalfopristin. The proportion of high-level aminoglycoside sensitive strains was 50.0% sensitive to gentamicin （13/26） and 65.4% sensitive to streptomycin （17/26） in E. faecalis, compared to 25.0% sensitive to gentamicin （6/24） and 62.5%sensitive to streptomycin （15/24） in E. faecium. Empirical antimicrobial therapy was prescribed in 46 cases before knowing blood culture results, of which 41 （89.1%） were inappropriate. Antimicrobial therapy was adjusted in 32 cases based on antimicrobial susceptibility tests. Seventeen patients improved and 2 died. Conclusions For enterococcal bloodstream infections, empirical antibiotic therapy

关 键 词：血流感染 肠球菌 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]