Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Ann Hematol. 2012 Jan;91(1):115-21. doi: 10.1007/s00277-011-1247-7. Epub 2011 May 10.
This study was performed to evaluate the impact of extended-spectrum β-lactamase (ESBL)-producing bacteremia on outcome in patients with hematologic malignancy. We collected and analyzed data on 156 hematologic malignancy patients with Escherichia coli or Klebsiella pneumoniae bacteremia from the database of nationwide surveillance studies for bacteremia. Thirty-seven of the 156 patients (23.7%) harbored ESBL-producing bacteremia. No significant differences in underlying diseases were found in either group. The multivariate analysis showed that significant factors associated with ESBL-producing bacteremia were ICU care (OR = 7.03, 95% CI = 1.79-27.6) and nosocomial acquisition (OR = 5.66, 95% CI = 1.60-20.23). There was an association between prior receipt of cephalosporins and ESBL-producing bacteremia, although this association was not statistically significant (OR = 2.27, 95% CI = 0.99-5.23). The overall 30-day mortality rate of the study population was 20.4% (29/142), and the 30-day mortality rate for the ESBL group was significantly higher than that for the non-ESBL group (44.8% vs. 14.2%, P < 0.001). Multivariate analysis showed that ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality (OR, 5.64; 95% CI, 1.91-16.67), along with ICU care (OR = 4.35, 95% CI = 1.16-16.26) and higher Pitt bacteremia score (per 1-point increment) (OR = 1.50, 95% CI = 1.18-1.92). In conclusion, ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality in patients with hematologic malignancy, along with ICU care and higher Pitt bacteremia score. Our data suggest that determining the optimal empiric antimicrobial therapy in patients with hematologic malignancy is now becoming a challenge for clinicians in the era of multidrug-resistant Gram-negative bacilli.
本研究旨在评估产超广谱β-内酰胺酶（ESBL）的大肠埃希菌或肺炎克雷伯菌菌血症对血液病患者结局的影响。我们从全国菌血症监测研究数据库中收集并分析了 156 例血液病合并大肠埃希菌或肺炎克雷伯菌菌血症患者的数据。在这 156 例患者中，有 37 例（23.7%）携带产 ESBL 菌血症。两组患者的基础疾病无显著差异。多因素分析显示，与产 ESBL 菌血症相关的显著因素为 ICU 治疗（OR=7.03，95%CI=1.79-27.6）和医院获得性感染（OR=5.66，95%CI=1.60-20.23）。先前使用头孢菌素与产 ESBL 菌血症有关，但无统计学意义（OR=2.27，95%CI=0.99-5.23）。研究人群的 30 天总死亡率为 20.4%（29/142），ESBL 组的 30 天死亡率明显高于非 ESBL 组（44.8%比 14.2%，P<0.001）。多因素分析显示，产 ESBL 菌血症是与 30 天死亡率相关的最重要危险因素（OR，5.64；95%CI，1.91-16.67），此外还有 ICU 治疗（OR=4.35，95%CI=1.16-16.26）和较高的 Pitt 菌血症评分（每增加 1 分）（OR=1.50，95%CI=1.18-1.92）。总之，产 ESBL 菌血症是血液病患者 30 天死亡率相关的最重要危险因素，此外还有 ICU 治疗和较高的 Pitt 菌血症评分。我们的数据表明，在耐多药革兰阴性杆菌时代，确定血液病患者经验性抗菌治疗的最佳方案对临床医生来说是一个挑战。
