Kwon Jae-Cheol, Kim Si-Hyun, Choi Jae-Ki, Cho Sung-Yeon, Park Yeon-Joon, Park Sun Hee, Choi Su-Mi, Lee Dong-Gun, Choi Jung-Hyun, Yoo Jin-Hong
Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea. ; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Infect Chemother. 2013 Mar;45(1):51-61. doi: 10.3947/ic.2013.45.1.51. Epub 2013 Mar 29.
The aim of this study was to investigate the clinical features and epidemiology of bloodstream infections (BSIs) in 2 distinctive hematological wards of the Catholic Blood and Marrow Transplantation (BMT) center.
We retrospectively reviewed the medical data of patients who developed BSIs from June 2009 to May 2010 in 2 hematologic wards at the Catholic BMT center. Ward A is a 44-bed unit mainly conducting conventional high dose chemotherapy and ward B is a 23-bed unit exclusively conducting BMT.
Overall, 222 BSI episodes were developed from 159 patients. Acute myeloid leukemia in ward A and multiple myeloma in ward B were more frequent than in ward B and A, respectively. Sex, age, presence of neutropenia, shock, Pitt bacteremia score, type of central catheter, level of C-reactive protein, duration of admission days, type of BSI, overall mortality and distribution of organisms were not different between the 2 wards. There were 202 monomicrobial and 20 polymicrobial BSI episodes, including 2 fungemia episodes. The incidence rate of overall BSIs per 1,000 patient-days was higher in ward A than in ward B (incidence rate ratio 2.88, 95% confidence interval 1.97-4.22, P<0.001). Among 243 organisms isolated, the number of gram positives, gram negatives and fungi were 122, 119 and 2, respectively. Escherichia coli was the most common organism in both ward A and B (27.6% and 42.4%), followed by viridians streptococci (18.6% and 15.2%) and Klebsiella pneumoniae (13.3% and 9.0%). Extended spectrum beta-lactamase (ESBL) producers accounted for 31.9% (23/72) of E. coli and 71.0% (22/31) of K. pneumoniae. Out of 19 Enterococcus faecium, 7 isolates (36.8%) were resistant to vancomycin. The crude mortality rates at 7 and 30 days after each BSI episode were 4.5% (10/222) and 13.1% (29/222), and were significantly higher in the patients with shock compared with those without shock (20.5% vs. 1.1%, P<0.001 and 38.5% vs. 7.7%, P<0.001, respectively).
The incidence rate of BSIs was higher in patients receiving chemotherapy than those receiving BMT, but the distribution of organisms was not different between the 2 wards. E. coli was the most common causative BSI organism in hematologic wards followed by viridians streptococci and K. pneumoniae.
本研究旨在调查天主教血液与骨髓移植（BMT）中心两个不同血液科病房血流感染（BSIs）的临床特征和流行病学情况。
我们回顾性分析了2009年6月至2010年5月在天主教BMT中心两个血液科病房发生BSIs的患者的医疗数据。A病房有44张床位，主要进行传统高剂量化疗；B病房有23张床位，专门进行BMT。
总体而言，159例患者共发生222次BSI发作。A病房的急性髓系白血病和B病房的多发性骨髓瘤分别比B病房和A病房更为常见。两个病房在性别、年龄、中性粒细胞减少的存在、休克、皮特菌血症评分、中心导管类型、C反应蛋白水平、住院天数、BSI类型、总体死亡率和微生物分布方面并无差异。有202次单一微生物BSI发作和20次多微生物BSI发作，包括2次真菌血症发作。A病房每1000患者日的总体BSIs发病率高于B病房（发病率比2.88，95%置信区间1.97 - 4.22，P<0.001）。在分离出的243种微生物中，革兰氏阳性菌、革兰氏阴性菌和真菌的数量分别为122、119和2。大肠杆菌是A病房和B病房最常见的微生物（分别为27.6%和42.4%），其次是草绿色链球菌（分别为18.6%和15.2%）和肺炎克雷伯菌（分别为13.3%和9.0%）。产超广谱β-内酰胺酶（ESBL）的菌株分别占大肠杆菌的31.9%（23/72）和肺炎克雷伯菌的71.0%（22/31）。在19株粪肠球菌中，7株（36.8%）对万古霉素耐药。每次BSI发作后7天和30天的粗死亡率分别为4.5%（10/222）和13.1%（29/222），休克患者的死亡率显著高于无休克患者（分别为20.5%对1.1%，P<0.001；38.5%对7.7%，P<0.001）。
接受化疗的患者BSIs发病率高于接受BMT的患者，但两个病房的微生物分布并无差异。大肠杆菌是血液科病房BSI最常见的致病微生物，其次是草绿色链球菌和肺炎克雷伯菌。
