实体器官移植受者中耐药 ESKAPE 病原体引起菌血症的危险因素和结局。
Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients.
机构信息
1 Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 2 Microbiology Department, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Insituto de Salud Carlos III, Madrid, Spain. 3 General Surgery Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 4 Gastroenterology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 5 Cardiology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 6 Nefrology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 7 Address correspondence to: Marta Bodro, Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
出版信息
Transplantation. 2013 Nov 15;96(9):843-9. doi: 10.1097/TP.0b013e3182a049fd.
BACKGROUND
Although infections due to the six ESKAPE pathogens have recently been identified as a serious emerging problem, information regarding bacteremia caused by these organisms in solid-organ transplant (SOT) recipients is lacking. We sought to determine the frequency, risk factors, and outcomes of bacteremia due to drug-resistant ESKAPE (rESKAPE) organisms in liver, kidney, and heart adult transplant recipients.
METHODS
All episodes of bacteremia prospectively documented in hospitalized SOT recipients from 2007 to 2012 were analyzed.
RESULTS
Of 276 episodes of bacteremia, 54 (19.6%) were due to rESKAPE strains (vancomycin-resistant Enterococcus faecium [0], methicillin-resistant Staphylococcus aureus [5], extended-spectrum β-lactamase-producing Klebsiella pneumoniae [10], carbapenem-resistant Acinetobacter baumannii [8], carbapenem- and quinolone-resistant Pseudomonas aeruginosa [26], and derepressed chromosomal β-lactam and extended-spectrum β-lactamase-producing Enterobacter species [5]). Factors independently associated with rESKAPE bacteremia were prior transplantation, septic shock, and prior antibiotic therapy. Patients with rESKAPE bacteremia more often received inappropriate empirical antibiotic therapy than the others (41% vs. 21.6%; P=0.01). Overall case-fatality rate (30 days) was higher in patients with rESKAPE bacteremia (35.2% vs. 14.4%; P=0.001).
CONCLUSIONS
Bacteremia due to rESKAPE pathogens is frequent in SOT recipients and causes significant morbidity and mortality. rESKAPE organisms should be considered when selecting empirical antibiotic therapy for hospitalized SOT recipients presenting with septic shock, particularly those with prior transplantation and antibiotic use.
背景
尽管最近已确定六大 ESKAPE 病原体感染是一个严重的新出现问题，但有关实体器官移植 (SOT) 受者中这些病原体引起菌血症的信息仍很缺乏。我们旨在确定肝、肾和心脏成年 SOT 受者中耐药物 ESKAPE（rESKAPE）病原体引起菌血症的频率、危险因素和结局。
方法
对 2007 年至 2012 年住院 SOT 受者中前瞻性记录的所有菌血症病例进行了分析。
结果
在 276 例菌血症中，54 例（19.6%）由 rESKAPE 菌株引起（万古霉素耐药粪肠球菌[0]，耐甲氧西林金黄色葡萄球菌[5]，产超广谱β-内酰胺酶的肺炎克雷伯菌[10]，碳青霉烯类耐药鲍曼不动杆菌[8]，碳青霉烯类和喹诺酮类耐药铜绿假单胞菌[26]，以及去阻遏染色体β-内酰胺酶和超广谱β-内酰胺酶的产肠杆菌属[5]）。与 rESKAPE 菌血症独立相关的因素是先前的移植、感染性休克和先前的抗生素治疗。rESKAPE 菌血症患者接受经验性抗生素治疗的情况更常不合理（41% vs. 21.6%；P=0.01）。rESKAPE 菌血症患者的总体 30 天病死率（30 天）更高（35.2% vs. 14.4%；P=0.001）。
结论
rESKAPE 病原体引起的菌血症在 SOT 受者中很常见，可导致严重的发病率和死亡率。当对出现感染性休克的住院 SOT 受者选择经验性抗生素治疗时，尤其是那些有先前移植和抗生素使用史的患者，应考虑 rESKAPE 病原体。
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