Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.
University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
Ann Hematol. 2018 Nov;97(11):2225-2234. doi: 10.1007/s00277-018-3423-5. Epub 2018 Jul 4.
Infections and especially blood stream infections (BSI) with gram-negative bacteria (GNB) represent a major threat for patients with hematological diseases undergoing chemotherapy and mainly contribute to morbidity and mortality. In this retrospective single-center study, we analyzed the impact of BSI with different gram-negative multidrug-resistant bacteria (MDRGN) compared to BSI with antibiotic susceptible gram-negative bacteria. Data of 109 patients with hematological malignancies and GNB BSI were analyzed with overall survival (OS) 30 days after BSI being the primary endpoint. BSI with non-fermentative gram-negative bacteria were found in 26.6% of all patients and 73.4% suffered from a BSI with an Enterobacteriaceae. Thirty-two of 109 patients suffered from BSI with MDRGN. Characteristics of MDRGN and non-MDRGN BSI patients did not differ besides the fact that significantly more patients received an immunosuppressive therapy in the MDRGN BSI group. OS (30 days after BSI) of patients with MDRGN BSI was significantly lower (85.6 vs. 55.9%; p < 0.001) compared to patients with non-MDRGN BSI. Patients with MDRGN BSI with non-fermentative pathogens had a worse OS after 30 days compared to MDRGN BSI with Enterobacteriaceae and the same holds true for non-MDRGN BSI. In multivariate analysis of MDRGN BSI, non-fermenters and ICU admission were independently associated with increased 30-day mortality. Our data demonstrate the negative impact of non-fermentative gram-negative pathogens causing BSI compared to Enterobacteriaceae in hematological patients and thereby underlining the heterogeneity of gram-negative BSI.
感染，尤其是血液感染（BSI）与革兰氏阴性菌（GNB），是接受化疗的血液病患者的主要威胁，主要导致发病率和死亡率增加。在这项回顾性单中心研究中，我们分析了不同革兰氏阴性多重耐药菌（MDRGN）BSI 与抗生素敏感革兰氏阴性菌 BSI 相比的影响。分析了 109 例血液病和 GNB BSI 患者的数据，BSI 后 30 天的总体生存率（OS）是主要终点。所有患者中 26.6%为非发酵性革兰氏阴性菌 BSI，73.4%为肠杆菌科 BSI。109 例患者中有 32 例患有 MDRGN BSI。除了 MDRGN BSI 组中明显更多的患者接受免疫抑制治疗外，MDRGN 和非 MDRGN BSI 患者的特征并无差异。与非 MDRGN BSI 患者相比，MDRGN BSI 患者的 OS（BSI 后 30 天）显著降低（85.6%比 55.9%；p<0.001）。与肠杆菌科相比，MDRGN BSI 中非发酵病原体患者的 30 天生存率更差，而非 MDRGN BSI 患者也是如此。在 MDRGN BSI 的多变量分析中，非发酵菌和 ICU 入院与增加的 30 天死亡率独立相关。我们的数据表明，与肠杆菌科相比，血液系统疾病患者中非发酵性革兰氏阴性病原体引起的 BSI 具有负面影响，从而强调了革兰氏阴性菌 BSI 的异质性。
