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目的探讨肠球菌血流感染(BSI)的危险因素、临床特点、药物敏感性及预后因素,为临床治疗提供参考依据。方法回顾性分析2011年10月1日-2016年10月1日医院89例肠球菌BSI患者的临床资料,包括人口学情况、基础病、治疗、药敏和一般实验室检查资料;89例肠球菌BSI患者中30d死亡者32例(死亡组),余下57例患者为存活组。结果 89株肠球菌中,屎肠球菌37株,粪肠球菌52株;肠球菌BSI的易感因素:静脉置管、近期手术史、留置尿管、胃肠道感染、肺部感染;屎肠球菌和粪肠球菌对万古霉素和利奈唑胺的敏感率均为100.0%,屎肠球菌对青霉素G和氨苄西林的敏感率<14.0%,粪肠球菌对青霉素G和氨苄西林的敏感率>80.0%;肠球菌BSI 30d病死率为36.0%;单因素分析发现,存活组在年龄、合并脑血管病、冠心病、恶性肿瘤、免疫抑制治疗、慢性肾病、慢性肺病、留置导尿液、肺部感染、肝胆胰感染、血尿素、肌酐、降钙素原、低血压、无创机械通气、有创机械通气、使用血管活性药物、屎肠球菌感染方面低于死亡组;在血小板、白蛋白、氧合指数、合理抗感染治疗方面高于死亡组,两组差异有统计学意义(P<0.05);logistic回归分析发现,慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,而合理的抗感染治疗是保护因素。结论屎肠球菌和粪肠球菌对万古霉素和利奈唑胺仍保持着高敏感性,但屎肠球菌的耐药性要高于粪肠球菌;慢性肾病、恶性肿瘤、屎肠球菌感染是肠球菌BSI死亡的独立危险因素,合理抗感染治疗是肠球菌BSI死亡的独立保护因素。
Objective To investigate the risk factors, clinical features, drug sensitivity and prognostic factors of enterococcal bloodstream infection (BSI), and to provide a reference for clinical treatment. Methods The clinical data of 89 patients with enterococci BSI from October 1, 2011 to October 1, 2016 in our hospital were retrospectively analyzed. The data of demography, basic diseases, treatment, drug sensitivity and general laboratory tests were retrospectively analyzed. 89 patients 32 patients died of cocci BSI in 30 days (death group), and the remaining 57 patients were survival group. Results Among the 89 enterococci, there were 37 Enterococcus faecium and 52 Enterococcus faecalis; the predisposing factors of enterococci BSI were venous catheterization, recent operation history, indwelling catheter, gastrointestinal tract infection and lung infection; The susceptibilities of cocci and enterococcus faecalis to vancomycin and linezolid were both 100.0%, the sensitivity of Enterococcus faecium to penicillin G and ampicillin was <14.0%, the sensitivity of Enterococcus faecalis to penicillin G and ampicillin> 80.0%; Enterococci BSI 30d mortality was 36.0%; univariate analysis found that the survival group in age, with cerebrovascular disease, coronary heart disease, cancer, immunosuppressive therapy, chronic kidney disease, chronic lung disease, indwelling catheter, lung Department of infection, hepatobiliary and pancreatic infection, blood urea, creatinine, procalcitonin, hypotension, non-invasive mechanical ventilation, invasive mechanical ventilation, the use of vasoactive drugs, enterococcus faecium infection was lower than the death group; in platelets, albumin, Oxygenation index, reasonable anti-infective treatment than the death group, the difference between the two groups was statistically significant (P <0.05); logistic regression analysis found that chronic nephropathy, malignant tumors, Enterococcus faecium infection is an independent risk of enterococci BSI death Factors, and together Anti-infective therapy is a protective factor. Conclusion Enterococcus faecalis and Enterococcus faecalis remain highly sensitive to vancomycin and linezolid, but Enterococcus faecium is more resistant than Enterococcus faecalis; chronic kidney disease, The independent risk factor for the death of cocci BSI, reasonable anti-infective therapy is an independent protective factor of the death of enterococci BSI.