肠球菌属血流感染耐药性特征及短期预后的危险因素分析

摘要 目的：观察肠球菌属血流感染（EBSI）耐药性特征，并分析患者短期预后的危险因素。方法：收集我院2020年2月~2021年9月期间收治的130例EBSI患者的临床资料进行回顾性分析，观察EBSI耐药性特征，并分析患者短期预后的危险因素。结果：130例EBSI患者共分离出130株非重复性肠球菌属，分别为：粪肠球菌37株，屎肠球菌84株，鹑鸡肠球菌3株，鸟肠球菌6株。屎肠球菌对利奈唑胺、万古霉素、喹奴普汀/达福普汀、替考拉宁的耐药率较低。粪肠球对青霉素G、氨苄西林、万古霉素、替考拉宁、利奈唑胺呈较低的耐药率。单因素分析结果显示，EBSI短期预后与糖皮质激素治疗、植入导管或其他人工装置、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）评分、血液透析情况、休克情况、选用敏感药物治疗情况有关（P<0.05）。多因素Logistic回归分析结果显示，有糖皮质激素治疗、未选用敏感药物治疗、有休克、植入导管或其他人工装置是EBSI短期预后的危险因素（P<0.05）。结论：EBSI患者肠球菌属分布以屎肠球菌、粪肠球菌为主，两种肠球菌属耐药率均较高，应严格控制用药。应着重注意有糖皮质激素治疗、未选用敏感药物治疗、有休克、有导管或其他人工装置的患者，以改善EBSI患者短期预后。

Analysis of Drug Resistance Characteristics and Risk Factors for Short-Term Prognosis of Enterococcus Bloodstream Iinfection

ABSTRACT Objective: To observe Enterococcus bloodstream infection (EBSI) drug resistance characteristics, and to analyze the risk factors of short-term prognosis. Methods: The clinical data of 130 patients with EBSI who were treated in our hospital from February 2020 to September 2021 were collected and analyzed retrospectively. The EBSI drug resistance characteristics were observed, and the risk factors of short-term prognosis of patients were analyzed. Results: 130 strains non repetitive enterococci were isolated from 130 cases of patients with EBSI, including 37 strains of Enterococcus faecium, 84 strains of Enterococcus faecium, 3 strains of Enterococcus quail and 6 strains of Enterococcus avium. The drug resistance rates of Enterococcus faecium to linezolid, vancomycin, quniupristin/dalfopristin and teicoplanin were low. The drug resistance rate of fecal intestinal ball to penicillin G, ampicillin, vancomycin, teicoplanin and linezolid were low. Univariate analysis showed that the short-term prognosis of EBSI were related to glucocorticoid treatment, catheter implantation or other artificial devices, acute physiology and chronic health score II (APACHE II), hemodialysis situation, shock situation and the selection of sensitive drugs for treatment(P<0.05). Multivariate Logistic regression analysis showed that with glucocorticoid treatment, no selection of sensitive drug treatment, with shock, catheter implantation or other artificial devices were the risk factors for the short-term prognosis of EBSI (P<0.05). Conclusion: Enterococcus faecalis and Enterococcus faecalis are the main enterococci in patients with EBSI. The drug resistance rates of the two enterococci are high, so the drug use should be strictly controlled. Attention should be paid to patients with glucocorticoid therapy, no sensitive drugs for treatment, with shock, catheter or other artificial devices in order to improve the short-term prognosis of patients with EBSI.