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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 analyze the clinical features of Enterococci infection and the risk factors associated with death at 30 days after admission. Methods The clinical and microbiological data of patients with bloodstream infections caused by enterococci in our hospital from 2008 to 2015 were retrospectively analyzed. Results A total of 59 cases of enterococci bloodstream infections were observed, including 33 cases of Enterococcus faecalis, 24 cases of Enterococcus faecium, 1 case of Enterococcus faecalis and 1 case of Enterococcus faecalis. Enterococcus faecium group Charlson comorbidity score ≥ 5, glucocorticoid therapy and catheter-derived infection more than Enterococcus faecalis group were (62.5% vs 30.3%, 33.3% vs 9.1%, 83.3% vs 45.5% , P <0.05). No resistance to vancomycin-resistant enterococci (VRE) and Enterococcus faecium was found to be more resistant to ampicillin, ciprofloxacin and gentamicin at higher concentrations than those infected by E. faecalis, respectively (79.2% vs 3.0%, 75.0% vs 42.4%, 54.2% vs 21.2%, P <0.05). Univariate and multivariate regression analysis showed that only glucocorticoid treatment (OR = 7.644, P <0.05), intravenous catheter infection (OR = 9.727, P <0.05) and ciprofloxacin resistance (OR = 15.060, P < 0.05) was an independent risk factor for death at 30 days after admission. Conclusion Enterococcus faecalis and Enterococcus faecium are two different pathogens, resulting in different characteristics of bloodstream infections should be more active empirical anti-infective therapy to improve the prognosis.