Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
J Microbiol Immunol Infect. 2011 Aug;44(4):282-8. doi: 10.1016/j.jmii.2010.08.004. Epub 2011 Jan 20.
Clinical information about bacteremia due to extended-spectrum β-lactamase (ESBL)-producing pathogens in cancer patients was limited. The study was aimed to identify the clinical manifestations and risk factors for mortality in ESBL-producer bacteremia in cancer patients.
A retrospective study of bacteremia caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae in adults with cancer in National Cheng Kung University Hospital and National Taiwan University Hospital from July 2002 to August 2007 was conducted. Clinical characteristics, initial manifestations, and antimicrobial therapy were analyzed for their association with crude mortality at 14 days after bacteremia onset.
A total 113 episodes of bacteremia caused by E coli (59.3%), K pneumoniae (39.8%) or both (0.9%) were included. Patients with hematological malignancy were younger (55 ± 22 vs. 69 ± 14 years, p < 0.003) and had less co-morbidity, but were more likely to have neutropenia (73.1% vs. 4.6%, p < 0.001) than those with solid tumor. By the univariate analysis in 113 episodes of ESBL-producer bacteremia, several risk factors, including pneumonia or soft-tissue infection as the bacteremia source, initial manifestations with high Pitt bacteremia scores, shock, respiratory failure or severe sepsis, and inappropriate definitive therapy were associated with 14-day crude mortality. By multivariate analysis, only pneumonia [adjusted odds ratio (AOR), 5.2; 95% confident interval (CI), 1.3-21.0; p = 0.021], severe sepsis (AOR, 24.3; 95% CI, 5.6-105.0; p < 0.001), and inappropriate definitive therapy (AOR, 11.3; 95% CI, 1.7-72.8; p = 0.011) were independently associated with a fatal outcome.
The presence of neutropenia or underlying hematological malignancy in cancer patients with ESBL-producer bacteremia was not associated with an increase in the mortality rate. Appropriate definitive antimicrobial therapy will be beneficial in improving clinical outcome.
关于癌症患者产超广谱β-内酰胺酶（ESBL）的病原体引起菌血症的临床信息有限。本研究旨在确定 ESBL 生产者菌血症在癌症患者中的临床表现和死亡率的危险因素。
对 2002 年 7 月至 2007 年 8 月在国立成功大学医院和台湾大学医院因产 ESBL 的大肠埃希菌或肺炎克雷伯菌引起的成人菌血症进行回顾性研究。分析临床特征、初始表现和抗菌治疗与菌血症发病后 14 天的粗死亡率之间的关系。
共包括 113 例由大肠埃希菌（59.3%）、肺炎克雷伯菌（39.8%）或两者（0.9%）引起的菌血症。血液恶性肿瘤患者较年轻（55±22 岁 vs. 69±14 岁，p＜0.003）且合并症较少，但更有可能发生中性粒细胞减少症（73.1% vs. 4.6%，p＜0.001）比实体瘤患者。在 113 例 ESBL 生产者菌血症的单因素分析中，肺炎或软组织感染作为菌血症源、初始表现高 Pitt 菌血症评分、休克、呼吸衰竭或严重败血症以及不适当的明确治疗等几个危险因素与 14 天的粗死亡率相关。多因素分析表明，只有肺炎（调整后的优势比（AOR），5.2；95%置信区间（CI），1.3-21.0；p=0.021）、严重败血症（AOR，24.3；95%CI，5.6-105.0；p＜0.001）和不适当的明确治疗（AOR，11.3；95%CI，1.7-72.8；p=0.011）与致命结局独立相关。
癌症患者产 ESBL 菌血症中性粒细胞减少或基础血液恶性肿瘤与死亡率增加无关。适当的明确抗菌治疗将有利于改善临床结局。
