a From the Department of Transplant Surgery , Third Xiangya Hospital, Central South University , Changsha, Hunan , China.
b Key Laboratory of Medical Information Research (Central South University), College of Hunan Province , Changsha, Hunan , China.
Infect Dis (Lond). 2016;48(1):32-9. doi: 10.3109/23744235.2015.1051106. Epub 2015 Sep 2.
More data on bacteremia due to non-lactose fermenting gram-negative bacilli (NLF GNB) in solid organ transplant (SOT) recipients are needed. We aimed to investigate the epidemiology, microbiology, and risk factors for mortality and septic shock due to NLF GNB bacteremia in SOT recipients.
We performed a retrospective, double-center study over a 12-year study period. The risk factors for mortality and septic shock in SOT recipients with NLF GNB bacteremia were assessed with multivariate logistic regression analysis.
A total of 230 episodes of bloodstream infections (BSIs) occurred in 159 SOT recipients. Fifty episodes of NLF GNB bacteremia were detected in 47 SOT recipients, with a predominance of Acinetobacter baumanii (27 isolates, 54.0%). The antibiotic resistance rate of all NLF GNB to 10 of 12 antibiotics investigated was more than 50%. The independent risk factors associated with septic shock were platelet count < 50 000/mm(3) (odds ratio (OR) = 14.41, 95% confidence interval (CI) = 2.64-78.71, p = 0.002) and late-onset bacteremia (time of onset more than 2 months post-transplant) (OR = 10.87, 95% CI = 1.79-65.89, p = 0.009). Lung focus (OR = 32.91, 95% CI = 2.56-423.18, p = 0.007) and septic shock (OR = 70.38, 95% CI = 4.21-1176.21, p = 0.003) were risk factors for bacteremia-related mortality.
The drug resistance of the pathogens and the morbidity and mortality rates of NLF GNB bacteremia were high in SOT recipients. For septic shock, associated risk factors were thrombocytopenia and late-onset bacteremia. The risk factors significantly associated with mortality were lung focus and septic shock.
我们需要更多关于实体器官移植（SOT）受者非乳糖发酵革兰阴性杆菌（NLF GNB）菌血症的数据。我们旨在研究 NLF GNB 菌血症在 SOT 受者中导致死亡率和感染性休克的流行病学、微生物学和危险因素。
我们进行了一项回顾性、双中心研究，研究时间为 12 年。使用多变量逻辑回归分析评估 SOT 受者 NLF GNB 菌血症导致死亡率和感染性休克的危险因素。
在 159 名 SOT 受者中发生了 230 例血流感染（BSI）。在 47 名 SOT 受者中检测到 50 例 NLF GNB 菌血症，其中以鲍曼不动杆菌为主（27 株，54.0%）。所有 NLF GNB 对 12 种抗生素中的 10 种的抗生素耐药率均超过 50%。与感染性休克相关的独立危险因素是血小板计数<50,000/mm³（比值比（OR）=14.41，95%置信区间（CI）=2.64-78.71，p=0.002）和晚发型菌血症（发病时间超过移植后 2 个月）（OR=10.87，95%CI=1.79-65.89，p=0.009）。肺部病灶（OR=32.91，95%CI=2.56-423.18，p=0.007）和感染性休克（OR=70.38，95%CI=4.21-1176.21，p=0.003）是菌血症相关死亡率的危险因素。
SOT 受者 NLF GNB 病原体的耐药性以及菌血症的发病率和死亡率均较高。对于感染性休克，相关危险因素是血小板减少和晚发型菌血症。与死亡率显著相关的危险因素是肺部病灶和感染性休克。
