Predictors of mortality of enterococcal bacteraemia and the role of source control interventions; a retrospective cohort study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-05-22 DOI:10.1007/s15010-025-02561-5

Virgile Zimmermann, Nicolas Fourré, Laurence Senn, Benoit Guery, Matthaios Papadimitriou-Olivgeris

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引用次数: 0

Abstract

Purpose: To identify predictors of mortality among patients with enterococcal bacteraemia.

Methods: This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included adult patients with enterococcal bacteraemia from 2014 to 2023.

Results: During the study period, 768 enterococcal bacteraemia episodes were included. The predominant species was Enterococcus faecalis (427 episodes; 56%). Sepsis or septic shock were present in 351 (46%) episodes. The overall 30-day mortality rate was 19% (148 episodes). The Cox multivariable regression model showed that age > 60 years (aHR: 1.75, 95% CI: 1.05-2.90), nosocomial infection (1.78, 1.19-2.65), sepsis or septic shock (3.67, 2.48-5.45), and not performing source control interventions within 48 h, in patients on or discussing of transitioning to limitations of care (5.91, 3.13-11.14) were associated with 30-day mortality. Conversely, infectious diseases (ID) consultation within 48 h (0.40, 0.28-0.57), appropriate antimicrobial therapy within 48 h (0.54, 0.34-0.86), and source control interventions performed within 48 h (0.22, 0.14-0.36) or not warranted (0.54; 0.34-0.86) were associated with survival. Among the 737 episodes without limitation of care, the Cox multivariable regression model showed that nosocomial infection (1.78, 1.19-2.67), sepsis or septic shock (3.76, 2.42-5.82), were associated with 30-day mortality. Conversely, ID consultation within 48 h (0.44, 0.30-0.65), appropriate antimicrobial therapy within 48 h (0.51, 0.30-0.86), and source control interventions performed within 48 h (0.25, 0.16-0.40) or not warranted (0.40; 0.26-0.61) were associated with survival.

Conclusions: Our findings underscore the pivotal role of early management of enterococcal bacteraemia, including ID consultation, appropriate antimicrobial treatment initiation and performance of source control interventions.

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肠球菌菌血症死亡率的预测因素及源控制干预措施的作用回顾性队列研究。

目的：确定肠球菌菌血症患者死亡率的预测因素。方法：本回顾性研究在瑞士洛桑大学医院进行，纳入2014年至2023年肠球菌菌血症的成年患者。结果：在研究期间，共发生768例肠球菌菌血症。优势种为粪肠球菌（427次）；56%)。351例（46%）出现脓毒症或感染性休克。总30天死亡率为19%（148例）。Cox多变量回归模型显示，年龄0 ~ 60岁（aHR: 1.75, 95% CI: 1.05 ~ 2.90）、院内感染（1.78,1.19 ~ 2.65）、脓毒症或感染性休克（3.67,2.48 ~ 5.45）、48 h内未进行传染源控制干预、正在或正在讨论过渡到限制护理（5.91,3.13 ~ 11.14）与30天死亡率相关。相反，在48小时内进行传染病（ID）咨询（0.40,0.28-0.57），在48小时内进行适当的抗菌治疗（0.54,0.34-0.86），在48小时内进行源控制干预（0.22,0.14-0.36）或不需要(0.54；0.34-0.86)与生存率相关。在不限制护理的737例病例中，Cox多变量回归模型显示，院内感染（1.78,1.19-2.67）、脓毒症或感染性休克（3.76,2.42-5.82）与30天死亡率相关。相反，在48小时内进行ID咨询（0.44,0.30-0.65），在48小时内进行适当的抗菌治疗（0.51,0.30-0.86），在48小时内进行源控制干预（0.25,0.16-0.40）或不需要(0.40；0.26-0.61)与生存率相关。结论：我们的研究结果强调了肠球菌菌血症的早期管理的关键作用，包括ID咨询，适当的抗菌药物治疗开始和源控制干预措施的实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.