肠球菌属血流感染的临床特征和预后分析  

Analysis of clinical features and prognosis of bloodstream infections caused by Enterococcus spp

作　　者：郑金鑫[1] 蒲彰雅 徐芹珍[1] 王红燕[1] 李多云[1] 陈重[1] 邓向斌[1] 邓启文[1] 余治健[1] 

机构地区：[1]深圳大学附属南山区人民医院感染疾病科和深圳市内源性感染诊治重点实验室,广东深圳518052

出　　处：《中国热带医学》2016年第10期1027-1031,共5页China Tropical Medicine

基　　金：深圳市科技创新-知识创新计划项目(No.JCYJ20150402152130173);深圳市南山区卫生科技计划项目(No.2015019;2015022);深圳市重点学科经费资助(No.2015SN011)

摘　　要：目的分析肠球菌属血流感染的临床特征和入院后30 d死亡相关的危险因素。方法回顾分析本院2008—2015年由肠球菌属细菌所致血流感染患者的临床和微生物学资料。结果共59例肠球菌属血流感染患者,其中粪肠球菌33例,屎肠球菌24例,铅黄肠球菌和鹑鸡肠球菌各1例。屎肠球菌组Charlson合并症评分≥5、接受糖皮质激素治疗和静脉导管来源感染的患者多于粪肠球菌组,分别为(62.5%vs 30.3%、33.3%vs 9.1%、83.3%vs 45.5%,P<0.05)。未发现耐万古霉素肠球菌(VRE),屎肠球菌血流感染对氨苄西林、环丙沙星和高浓度庆大霉素的耐药率明显高于粪肠球菌血流感染患者,分别为(79.2%vs 3.0%、75.0%vs 42.4%、54.2%vs 21.2%,P<0.05)。通过单因素和多因素回归分析示仅糖皮质激素治疗(OR=7.644,P<0.05),静脉导管感染(OR=9.727,P<0.05)和环丙沙星耐药(OR=15.060,P<0.05)是患者入院后30 d死亡的独立危险因素。结论粪肠球菌和屎肠球菌是两种差别较大的病原体,所导致的血流感染有其不同特征,应更加积极的进行经验性抗感染治疗以改善预后。Objective To explore the profile of patients and characteristics of bloodstream infections（BSI） caused byEnterococcus spp strains in a teaching hospital and discover the risk factors for 30-day mortality. Methods A monocentricretrospective cohort study was carried out. All patients with BSI caused by Enterococcus spp between 2008 and 2015 wereincluded. The data of clinical features of the patients, microbiology, and 30-day mortality were collected from the electronicmedical record database and analyzed statistically. Results A total of 59 patients were included with BSI caused byEnterococcus spp：E. faecalis（n=33）, E. faecium（n=24）, E. casseliflavus（n=1） and E. gallinarum（n=1）. In the E. faeciumgroup, the Charlson co-morbidity score ≥5, and the rticosteroid treatment and catheter or other prosthetic device in the E.faecium BSI patients were more frequently than those in the E. faecalis BSI patients（62.5% vs 30.3%, 33.3% vs 9.1%, 83.3%vs 45.5%, P〈0.05, respectively）. The antimicrobial resistance of ampicillin, ciprofloxacin and high-level gentamicin in the E.faecium BSI group were also higher than those in the E. faecalis BSI group. No vancomycin resistant Enterococcus（VRE） wasfound in these strains. The corticosteroid treatment（OR=7.644, P〈0.05）, vascular catheter infection（OR=9.727, P〈0.05） andciprofloxacin resistance（OR=15.060, P〈0.05） were independently associated with the 30- day mortality by univariate andmultivariate analyses. Conclusion BSI with E. faecalis and E. faecium should be regarded as two clinically differentpathogens with unique microbiologic characteristics, and more positive empiric antimicrobial treatment should be carried out inthe patients with enterococcal BSI.

关 键 词：肠球菌属 血流感染 死亡率 危险因素 

分 类 号：R453.2[医药卫生—治疗学]