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首页> 外文期刊>Journal of Clinical Microbiology >Prevalence and Detection of Mixed-Population Enterococcal Bacteremia
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Prevalence and Detection of Mixed-Population Enterococcal Bacteremia

机译：混合人群肠球菌细菌血症的患病率和检测

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Mixed-population (heterogeneous) enterococcal bacteremia (MEB) is rarely reported. Based on one occasion in which Vitek2 missed a vancomycin-resistant subpopulation isolated from a patient, we developed a simple method to detect this subpopulation and determined MEB frequency. The four patients presented here had either Enterococcus faecium or Enterococcus faecalis bacteremia caused by both vancomycin-resistant enterococci (VRE) and vancomycin-susceptible enterococci (VSE). No prior common antibiotic therapy was observed, and bacteremia resolved with daptomycin, gentamicin, and/or linezolid treatment. In two cases, VRE presence was missed by Vitek2. To detect the VRE subpopulation, tryptic soy broth was inoculated from positive blood cultures and a saline suspension was inoculated to a vancomycin (6-μg/ml) (V6) plate. Two isolates from each patient were studied further. Relatedness was assessed by multilocus sequence typing, fitness was evaluated by growth curve and competition assays, and vanA presence was determined by PCR. MEB represented ～5% of all enterococcal bacteremias. All VRE subpopulations grew on V6 plates but were missed in two instances by Vitek2. VRE and VSE isolates from each patient were closely related and did not differ in overall fitness. All four VRE isolates and 2/4 VSE isolates were vanA positive. MEBs occur regardless of prior antimicrobial therapy, are relatively common in our hospital, and are important to detect. As far as we know, this study is the first to report heterogeneous E. faecalis bacteremia. There is a simple method to detect VRE subpopulations that may be missed by Vitek2.
机译：很少有人报告混合种群（异源）肠球菌菌血症（MEB）。基于Vitek2错过了从患者身上分离出的耐万古霉素的亚群的情况，我们开发了一种检测该亚群并确定MEB频率的简单方法。此处介绍的四名患者均由耐万古霉素的肠球菌（VRE）和易受万古霉素的肠球菌（VSE）引起的粪便肠球菌或粪肠球菌菌血症。以前没有观察到常用的抗生素治疗，达托霉素，庆大霉素和/或利奈唑胺治疗可消除菌血症。在两种情况下，Vitek2错过了VRE的存在。为了检测VRE亚群，从阳性血液培养物中接种了胰蛋白酶大豆肉汤，并将盐水悬浮液接种到万古霉素（6-μg/ ml）（V6）平板上。进一步研究了每位患者的两个分离株。通过多基因座序列类型评估相关性，通过生长曲线和竞争测定法评估适应性，并通过PCR确定 vanA 的存在。 MEB占所有肠球菌菌血症的约5％。所有VRE亚群均在V6平板上生长，但在两个实例中被Vitek2遗漏了。每个患者的VRE和VSE分离株密切相关，总体适应性无差异。所有四个VRE分离株和2/4 VSE分离株均为 vanA 阳性。 MEB的发生与之前的抗菌治疗无关，在我院相对常见，并且对检测很重要。据我们所知，这项研究是第一个报告异种屎肠球菌菌血症的研究。有一种简单的方法可以检测Vitek2可能遗漏的VRE子种群。

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