The Clinical Fectures Outcomes And Drug Resistance Analysis Of 117 Patients With Enterococcal Blood Stream Infection

Objective:To observethe clinical features,risk factors, outcomes and drug resistance of 117 patients with enterococcal bloodstream infections (BSI),and provide help for clinical diagnosis and treatment of entercoccal BSI.Methods:A retrospective study was carried out to analyze the medical records of 117 patients which were confirmed diagnosis with enterococcal bloodstream infections in the First Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to October 2014. According to enterococcus species, they were divided into two groups: E. f aecalis BSI group (37 cases) and E. f aecium BSI group (72 cases). This research analyzed patients’ demographic features,clinical fectures,laboratory examination, outcomes and drug resistance.Results:A total of 117 patients were selected, with 79 males, and the average age was 60.5±15.7 years old (ranged from 14 to 89 years). There were 72 cases of E.faecium,37 cases of E.faecalis,5 cases of E.avium and 3 cases of E.gallinarum. Male,liver disease,cardiovascular disease,invasive procedures,abdominal surgery, received antibiotic treatment in two weeks before a positive culture may were risk factors of entercoccal BSI.96 patients had different degrees of fever. According to univariate analysis,there were great differences between two groups in APACHE II score, hospital stay, MODS, received corticosteroid therapy and arteriovenous catheter. There were significant differences between two groups in drug resistance to penicillin G,ampicillin,quinolones(P<0.05). There were 4 cases of vancomycin-resistant strains,6 cases of linezolid-resistant strains,4 cases of linezolid-medium sensitive stains,none of tigecycline-resistant. Among 10 cases of linezolid-nonsusceptible entercoccal BSI,9 cases received active antimicrobial therapy,7 cases blood culture were negative (bacteria removal),6 cases were clincical improved,4 cases died of MODS. The 30-day mortality of entercoccal BSI was 23.9%. In multivariate analysis, received corticosteroid therap,shock,and not receiving active antimicrobial therapy. were independent predictive factors for 30-day mortality. No significant association were found between E.faecium BSI and the increased mortality.Conclusion:Entercoccal BSI in patients with immune deficiencies showed high mortality.Independent risk factors for the 30-day mortality were received corticosteroid therapy,shock,and not receiving active antimicrobial therapy.E.faecium is associated with higher antimicrobial resistance and infection rate.The patients due to E.faecium BSI are associated with more severe underlying diseases,who meet more difficulty in the clinical treatment.