Department of Infectious Disease, Fujian Medical University Union Hospital, Fuzhou, Fujian, 350001, China.
Department of Clinical Laboratory, Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China.
J Infect Public Health. 2019 Jan-Feb;12(1):26-31. doi: 10.1016/j.jiph.2018.08.002. Epub 2018 Aug 23.
Carbapenem resistant Enterobacteriaceae (CRE) has become a serious public health problem. Limited information is available about the treatment options that physicians used to fight CRE infections and related clinical outcomes in China. The aim of the present study was to explore the treatment options and clinical outcomes of patients with CRE bloodstream infection (BSI) in a Chinese teaching hospital.
A retrospective study was conducted during 2011 to 2015 in one Chinese teaching hospital. Demographic, microbiological and clinical characteristics of enrolled subjects were collected from medical records. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression.
A total of 98 inpatients with CRE BSI were enrolled in this study. For empirical therapy, 26 patients (26.5%) received at least one active drug within 48h after the onset of bacteremia. For definitive treatment, 59.2% (49/82) patients received at least one active drug and 40.2% (33/82) patients received therapy with no active drug. The overall 30-day mortality was 53.1% (52/98). Adverse outcome appeared to be more likely among patients with previous carbapenem exposure, neutropenia, severity of septic and time to initiation of BSIs. There was no significant difference in the mortality between the two groups of patients with combination therapy versus monotherapy (p=0.105). Severity of sepsis and neutropenia were identified as independent predictors of mortality.
Our study demonstrated a high mortality associated with CRE BSI and a high percentage of inappropriate empirical treatment for CRE BSI patients in a Chinese teaching hospital. Particular attention should be given to the patients with CRE BSI.
耐碳青霉烯肠杆菌科（CRE）已成为严重的公共卫生问题。关于中国医生用于治疗 CRE 感染和相关临床结局的治疗选择，相关信息有限。本研究旨在探讨中国某教学医院 CRE 血流感染（BSI）患者的治疗选择和临床结局。
对 2011 年至 2015 年期间在中国某教学医院进行的一项回顾性研究进行了分析。从病历中收集了纳入患者的人口统计学、微生物学和临床特征。通过 Kaplan-Meier 图、对数秩检验和 Cox 回归进行数据分析。
本研究共纳入 98 例 CRE BSI 住院患者。对于经验性治疗，26 例（26.5%）在菌血症发生后 48 小时内接受了至少一种有效药物。对于确定性治疗，59.2%（49/82）的患者接受了至少一种有效药物，40.2%（33/82）的患者接受了无有效药物治疗。总的 30 天死亡率为 53.1%（52/98）。有碳青霉烯类药物暴露史、中性粒细胞减少症、脓毒症严重程度和 BSI 开始时间的患者不良结局发生的可能性更大。联合治疗组与单药治疗组的死亡率无显著差异（p=0.105）。脓毒症严重程度和中性粒细胞减少症是死亡的独立预测因素。
我们的研究表明，在中国某教学医院，CRE BSI 患者的死亡率较高，且 CRE BSI 患者的经验性治疗不当比例较高。应特别关注 CRE BSI 患者。
