Malagola Michele, Rambaldi Bendetta, Ravizzola Giuseppe, Cattaneo Chiara, Borlenghi Erika, Polverelli Nicola, Turra Alessandro, Morello Enrico, Skert Cristina, Cancelli Valeria, Cattina Federica, Giannetta Giorgio, Bernardi Simona, Perucca Simone, Almici Camillo, Roccaro Aldo, Signorini Liana, Stellini Roberto, Castelli Francesco, Caruso Arnaldo, Russo Domenico
Chair of Hematology, Clinical and Experimental Sciences Department, University of Brescia, Bone Marrow Transplant Unit, ASST-Spedali Civili, Brescia, Italy, Italy.
Institute of Microbiology, Department of Molecular and Transplational Medicine, University of Brescia, Italy.
Mediterr J Hematol Infect Dis. 2017 Jun 20;9(1):e2017036. doi: 10.4084/MJHID.2017.036. eCollection 2017.
Blood stream infections (BSIs) represent a major complication of allo-SCT and are a major cause of morbidity and mortality during and after bone marrow aplasia.
The objective of this study was to describe the incidence and outcome of BSIs in a cohort of patients submitted to allo-SCT, in order to track changes of the epidemiology and bacteria resistance.
We retrospectively analyzed the microbiological data of 162 patients allotransplanted in Brescia University Hospital, over a period of 6 years.
Eighty patients experienced a BSIs for a total of 119 isolates. In 77 cases (65%) a Gram positive bacteria was isolated, being coagulase negative the most frequent species (77% of the cases). In 42 cases (35%) a Gram negative bacteria was isolated (. 57% and P. 24%). Fluoroquinolones resistance was frequent (90% for , 92% for E. , 90% for ). Methycillin resistance of was 100%, 76% of were ESBL positive and among resistance to carbapenems was 40%. The 2 years overall survival of patients with BSIs patients without BSIs was 46% vs 60% (HR1,48, p=0,07). and were the species with the highest mortality (50% and 33%, respectively).
These data confirm that BSIs, mainly sustained by Gram positive bacteria, are frequent in allotransplanted patients (50% of the cases) and may influence the outcome of allotransplanted patients, being antibiotics resistance highly frequent among these bacteria.
血流感染（BSIs）是异基因造血干细胞移植（allo-SCT）的主要并发症，也是骨髓再生障碍期间及之后发病和死亡的主要原因。
本研究的目的是描述接受allo-SCT的一组患者中BSIs的发生率和结局，以追踪流行病学和细菌耐药性的变化。
我们回顾性分析了布雷西亚大学医院6年间162例接受同种异体移植患者的微生物学数据。
80例患者发生了BSIs，共分离出119株菌株。77例（65%）分离出革兰氏阳性菌，凝固酶阴性葡萄球菌是最常见的菌种（占病例的77%）。42例（35%）分离出革兰氏阴性菌（肺炎克雷伯菌占57%，铜绿假单胞菌占24%）。氟喹诺酮类耐药很常见（大肠埃希菌为90%，肺炎克雷伯菌为92%，铜绿假单胞菌为90%）。耐甲氧西林金黄色葡萄球菌的耐药率为100%，肺炎克雷伯菌的76%产超广谱β-内酰胺酶（ESBL）阳性，铜绿假单胞菌对碳青霉烯类的耐药率为40%。发生BSIs的患者与未发生BSIs患者的2年总生存率分别为46%和60%（风险比1.48，p = 0.07）。肺炎克雷伯菌和铜绿假单胞菌的死亡率最高（分别为50%和33%）。
这些数据证实，BSIs在同种异体移植患者中很常见（占病例的50%），主要由革兰氏阳性菌引起，可能影响同种异体移植患者的结局，这些细菌的抗生素耐药性非常普遍。
