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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 To analyze the clinical characteristics of enterococcal bloodstream infection and the distribution of pathogens, providing the basis for clinical diagnosis and treatment. Methods A retrospective analysis of 50 patients with enterococcal bloodstream infection in a top-tier hospital in Xiamen from January 2013 to December 2014 was conducted. Bacterial identification and susceptibility testing using the French biomedical VITEK2-Compact automatic microbial analysis system. Drug sensitivity statistics using WHONET 5.6 software. Results The pathogenic bacteria isolated from 50 cases of enterococci bloodstream infection included 26 strains of Enterococcus faecalis and 24 strains of Enterococcus faecium. The underlying diseases included 17 cases of tumor, 5 cases of type 2 diabetes and 3 cases of acute cholangitis. Susceptibility factors included catheter indwelling 29 cases, surgery 19 cases, hypoalbuminemia 6 cases, neutropenia 5 cases, ICU admitted in 7 cases, the use of ventilator 5 cases. 23 patients had primary infection, of which the number of cases of enterococci infection / infection was 56.5% (13/23): urinary tract infection 6/7, surgical site infection 4/4 and biliary infection 1/4. Enterococcus faecalis and Enterococcus faecium are completely susceptible to vancomycin, linezolid and tigecycline. Enterococcus faecalis is all susceptible to penicillin and ampicillin, whereas Enterococcus faecium is 100% sensitive to quinupristin-darfopressin. Enterococcus faecalis strains sensitive to high concentrations of aminoglycosides were gentamicin 50.0% (13/26), streptomycin 65.4% (17/26), feces enterococci gentamicin 25.0% (6 / 24) and streptomycin 62.5% (15/24). Forty-six patients experienced antecedent use of antimicrobial agents prior to the return of blood culture results, and 41 experienced antimicrobial therapy was inappropriate (89.1%). Thirty-two patients were targeted to adjust their medication based on susceptibility results, 17 were improved and 2 died. Conclusions For Enterococcus faecalis infection, the clinical experience of antimicrobial therapy is often not appropriate, the prognosis is not ideal; Enterococcus faecalis and Enterococcus faecium sensitivity to antibiotics there are some differences in time according to the drug susceptibility results of targeted antibacterial treatment of infected Control and prognosis of patients have a positive meaning.