BACKGROUND: Enterococci are an important cause of central venous catheter (CVC)-associated bloodstream infections (CA-BSI). It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.METHODS: A 12-month retrospective cohort study of adults with enterococcal CA-BSI was conducted at a tertiary care hospital; clinical, microbiological and outcome data were collected.RESULTS: A total of 111 patients had an enterococcal CA-BSI. The median age was 58.2 years (range 21 to 94 years). There were 45 (40.5%) infections caused by Entercoccus faecalis (among which 10 [22%] were vancomycin resistant), 61 (55%) by Enterococcus faecium (57 [93%] vancomycin resistant) and five (4.5%) by other Enterococcus species. Patients were treated with linezolid (n=51 [46%]), vancomycin (n=37 [33%]), daptomycin (n=11 [10%]), ampicillin (n=2 [2%]) or quinupristin/dalfopristin (n=2 [2%]); seven (n=6%) patients did not receive adequate enterococcal treatment. Additionally, 24 (22%) patients received adjunctive gentamicin treatment. The CVC was retained in 29 (26.1%) patients. Patients with removed CVCs showed lower rates of in-hospital mortality (15 [18.3%] versus 11 [37.9]; P=0.03), but similar rates of recurrent bacteremia (nine [11.0%] versus two (7.0%); P=0.7) and a similar post-BSI length of hospital stay (median days [range]) (11.1 [1.7 to 63.1 days] versus 9.3 [1.9 to 31.8 days]; P=0.3). Catheter retention was an independent predictor of mortality (OR 3.34 [95% CI 1.21 to 9.26]).CONCLUSIONS: To the authors’ knowledge, the present article describes the largest enterococcal CA-BSI series to date. Mortality was increased among patients who had their catheter retained. Additional prospective studies are necessary to determine the optimal management of enterococcal CA-BSI.

中文翻译：

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导管移除与保留治疗导管相关肠球菌血流感染。

背景：肠球菌是导致中心静脉导管 (CVC) 相关血流感染 (CA-BSI) 的重要原因。目前尚不清楚是否需要去除 CVC 才能成功治疗肠球菌 CA-BSI。收集了临床、微生物学和结果数据 结果：共有 111 名患者患有肠球菌 CA-BSI。中位年龄为 58.2 岁（范围 21 至 94 岁）。由粪肠球菌引起的感染有 45 例（40.5%）（其中 10 例 [22%] 对万古霉素耐药）、61 例（55%）由粪肠球菌引起（57 例 [93%] 万古霉素耐药）和 5 例（4.5%）由其他肠球菌物种。患者接受了利奈唑胺（n = 51 [46%]）、万古霉素（n = 37 [33%]）、达托霉素（n = 11 [10%]）、氨苄西林（n = 2 [2%]）或奎奴普丁 /达福普汀（n = 2 [2%]）；7 名（n = 6%）患者没有接受足够的肠球菌治疗。此外，24 名 (22%) 患者接受了庆大霉素的辅助治疗。29 名 (26.1%) 患者保留了 CVC。移除 CVC 的患者显示出较低的院内死亡率（15 [18.3%] 比 11 [37.9]；P = 0.03），但复发性菌血症的比率相似（9 [11.0%] 比 2 (7.0%)；P = 0.7）和类似的 BSI 后住院时间（中位天数 [范围]）（11.1 [1.7 至 63.1 天] vs 9.3 [1.9 至 31.8 天]；P = 0.3）。导管保留是死亡率的独立预测因子（OR 3.34 [95% CI 1.21 至 9.26]）。结论：据作者所知，本文描述了迄今为止最大的肠球菌 CA-BSI 系列。保留导管的患者死亡率增加。需要额外的前瞻性研究来确定肠球菌 CA-BSI 的最佳管理。