CAJ | 학술논문

目的：研究粪肠球菌和屎肠球菌血流感染（BSI）的临床特点、细菌耐药性及感染易患因素。方法回顾性分析四川省人民医院2011年1月—2013年11月确诊的成人粪肠球菌和屎肠球菌 BSI 临床和病原学资料。结果92例患者中分离出粪肠球菌21例，屎肠球菌71例；其中社区获得性感染25例，医院感染67例。粪肠球菌 BSI 患者的主要基础疾病为尿毒症（42．9％）、心脏病（23．8％）、肺部疾病（19．0％）和神经系统疾病（19．0％）；屎肠球菌 BSI 患者的主要基础疾病为肝、胆、胰腺疾病，各种肿瘤和肺部疾病，分别占40．8％；主要易感因素包括中心静脉置管（73．2％）、30 d 内手术史（62．0％）、年龄65岁以上（52．1％）、入住重症监护病房（ICU）（32．4％）和有创机械通气（26．8％）。粪肠球菌对氨苄西林和万古霉素敏感率为100％，对青霉素敏感率为95．2％，对利奈唑胺敏感率90．4％；屎肠球菌对利奈唑胺和万古霉素敏感率分别为100％和96．9％，对氨苄西林、青霉素耐药率高于90％。年龄65岁以上、入住 ICU、有创机械通气和罹患肿瘤是肠球菌属 BSI 患者在入院15 d 内死亡的独立危险因素，48 h 内合理抗菌药物应用是 BSI 患者15 d 内免于死亡的保护因素；基础疾病为肝、胆、胰腺疾病患者病死率较低。结论肠球菌属 BSI 以屎肠球菌为主，屎肠球菌耐药率明显高于粪肠球菌；年龄65岁以上、入住 ICU、有创机械通气和罹患肿瘤是肠球菌属 BSI 患者入院15 d 内死亡的独立危险因素，48 h 内使用有效抗菌药物可降低病死率。
목적：연구분장구균화시장구균혈류감염（BSI）적림상특점、세균내약성급감염역환인소。방법회고성분석사천성인민의원2011년1월—2013년11월학진적성인분장구균화시장구균 BSI 림상화병원학자료。결과92례환자중분리출분장구균21례，시장구균71례；기중사구획득성감염25례，의원감염67례。분장구균 BSI 환자적주요기출질병위뇨독증（42．9％）、심장병（23．8％）、폐부질병（19．0％）화신경계통질병（19．0％）；시장구균 BSI 환자적주요기출질병위간、담、이선질병，각충종류화폐부질병，분별점40．8％；주요역감인소포괄중심정맥치관（73．2％）、30 d 내수술사（62．0％）、년령65세이상（52．1％）、입주중증감호병방（ICU）（32．4％）화유창궤계통기（26．8％）。분장구균대안변서림화만고매소민감솔위100％，대청매소민감솔위95．2％，대리내서알민감솔90．4％；시장구균대리내서알화만고매소민감솔분별위100％화96．9％，대안변서림、청매소내약솔고우90％。년령65세이상、입주 ICU、유창궤계통기화리환종류시장구균속 BSI 환자재입원15 d 내사망적독립위험인소，48 h 내합리항균약물응용시 BSI 환자15 d 내면우사망적보호인소；기출질병위간、담、이선질병환자병사솔교저。결론장구균속 BSI 이시장구균위주，시장구균내약솔명현고우분장구균；년령65세이상、입주 ICU、유창궤계통기화리환종류시장구균속 BSI 환자입원15 d 내사망적독립위험인소，48 h 내사용유효항균약물가강저병사솔。
Objective To evaluate the clinical,microbiological and epidemiological characteristics of enterococcal bloodstream infections (BSIs).Methods Microbiological and clinical data were retrospectively collected and reviewed for the adult patients with enterococcal BSI who were treated in Sichuan Provincial People′s Hospital from January 1,2011 to November 30,2013. Results Of the 92 cases of enterococcal BSIs,21 were due to E.faecalis and 71 were caused by E.faecium,respectively.The BSI was hospital acquired in 67 cases.The other were community acquired BSI.E.faecalis BSIs were complicated with uremia (42.9%),heart disease (23.8%),pulmonary infection (19.0%)and central neurological disorder (19.0%),while E. faecium BSIs were complicated with hepatobiliary and pancreatic diseases (40.8%),neoplastic disease(40.8%)and pulmonary infection (40.8%).Risk factors for E.faecium acquisition were mainly central venous catheter (73.2%),recent surgey within 30 days (62.0%),elderly patients (52.1%),ICU admission (32.4%)and invasive mechanical ventilation (26.8%).Strains of E.faecalis were 100% susceptible to ampicillin and vancomycin,90.4% to linezolid.Strains of E.faecium were 100%susceptible to linezolid,96.9% to vancomycin, and approximately 90% resistant to ampicillin and penicillin. Logistic with hepatobiliary and pancreatic diseases had lower mortality rate than other patients.Conclusions E .faecium is responsible for majority of the enterococcal BSIs.E .faecium strains have higher resistance rate to most antimicrobial agents tested than E . fecalis .Elderly patients,ICU admission,invasive mechanical ventilation and neoplastic diseases are the independent risk factors of 15-day mortality.Adequate antimicrobial therapy within 48 hours can decrease the mortality rate effectively.