Chu L, Ye Q F, Wan Q Q, Zhou J D
The Pathology Department, Third Xiangya Hospital, Central South University, Changsha, Hunan, The People's Republic of China.
Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, the People's Republic of China; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, the People's Republic of China.
Transplant Proc. 2015 Oct;47(8):2450-5. doi: 10.1016/j.transproceed.2015.08.005.
A sustained immunosuppressive state in renal transplant recipients is a factor that can contribute to increased incidence of acute respiratory distress syndrome (ARDS) due to pneumonia. ARDS renal recipients with ESKAPE (E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and Enterobacter spp.) pneumonia are probably related to high morbidity and mortality. We therefore sought to investigate the frequency of ESKAPE and resistant ESKAPE (rESKAPE) pathogens isolated from respiratory tract specimens of renal recipients with ARDS and determine the risk factors for mortality.
A retrospective analysis of ARDS renal recipients with ESKAPE/rESKAPE pneumonia was reviewed. Multiple logistic regression analysis was conducted to identify the independent risk factors associated with infection-related mortality.
During the study period, 88 ESKAPE pathogens obtained from respiratory tract specimens of 54 ARDS renal recipients were documented including 33 A. baumannii, 24 P. aeruginosa, 17 S. aureus, 6 K. pneumoniae, 8 Enterobacter species, and 0 E. Faecium. Among these ESKAPE organisms, 61.4% (54/88) were antimicrobial resistant. The risk factors for mortality independently associated with ARDS renal recipients with ESKAPE pneumonia were severe ARDS (odds ratio [OR] 4.3 (95% confidence interval [CI] 1.1-16.4), P = .032), serum creatinine level >1.5 mg/dL (OR 4.2 95% CI (1.0-17.9), P = .05) and body temperature less than 38°C (OR 5.0 (95% CI 1.3-19.6), P = .02) at ARDS onset. The independent determinants of mortality were associated with ARDS renal recipients with rESKAPE pneumonia were serum creatinine level >1.5 mg/dL (OR 13.7, 95% CI 1.3-142.1, P = .028) and body temperature less than 38°C (OR 5.5 (95% CI 1.1-26.6) at ARDS onset, P = .035).
The majority of EPKAPE isolates were antimicrobial resistant. Mortality in ARDS renal recipients with ESKAPE/rESKAPE pneumonia was associated with the severity of ARDS, elevated serum creatinine level, or depressed febrile response at ARDS onset.
肾移植受者持续的免疫抑制状态是导致因肺炎引发急性呼吸窘迫综合征（ARDS）发病率增加的一个因素。患有ESKAPE（粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌属）肺炎的ARDS肾移植受者可能与高发病率和死亡率相关。因此，我们试图调查从患有ARDS的肾移植受者呼吸道标本中分离出的ESKAPE和耐药ESKAPE（rESKAPE）病原体的频率，并确定死亡风险因素。
对患有ESKAPE/rESKAPE肺炎的ARDS肾移植受者进行回顾性分析。进行多因素逻辑回归分析以确定与感染相关死亡率相关的独立风险因素。
在研究期间，记录了从54名ARDS肾移植受者的呼吸道标本中获得的88种ESKAPE病原体，包括33株鲍曼不动杆菌、24株铜绿假单胞菌、17株金黄色葡萄球菌、6株肺炎克雷伯菌、8株肠杆菌属和0株粪肠球菌。在这些ESKAPE微生物中，61.4%（54/88）具有抗菌耐药性。与患有ESKAPE肺炎的ARDS肾移植受者独立相关的死亡风险因素为严重ARDS（比值比[OR]4.3（95%置信区间[CI]1.1 - 16.4），P = .032）、血清肌酐水平>1.5 mg/dL（OR 4.2 95% CI（1.0 - 17.9），P = .05）以及ARDS发作时体温低于38°C（OR 5.0（95% CI 1.3 - 19.6），P = .02）。与患有rESKAPE肺炎的ARDS肾移植受者相关的死亡独立决定因素为血清肌酐水平>1.5 mg/dL（OR 13.7，95% CI 1.3 - 142.1，P = .028）以及ARDS发作时体温低于38°C（OR 5.5（95% CI 1.1 - 26.6），P = .035）。
大多数EPKAPE分离株具有抗菌耐药性。患有ESKAPE/rESKAPE肺炎的ARDS肾移植受者的死亡率与ARDS的严重程度、血清肌酐水平升高或ARDS发作时发热反应降低有关。
