Niu Tianshui, Xiao TingTing, Guo Lihua, Yu Wei, Chen Yunbo, Zheng Beiwen, Huang Chen, Yu Xiao, Xiao Yonghong
Collaborative Initiative Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China,
Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China.
Infect Drug Resist. 2018 Oct 26;11:2021-2030. doi: 10.2147/IDR.S169432. eCollection 2018.
Carbapenem-resistant (CRAB) is a rapidly emerging, life-threatening nosocomial infection. This study aimed to explore the risk factors, clinical features, antimicrobial therapy, and outcomes of CRAB bloodstream infections (BSIs).
This is a retrospective, comparative analysis of data from patients with BSI, treated from 2012 to 2015 at a tertiary teaching hospital. Risk factors associated with CRAB BSI and factors associated with the 28-day mortality were evaluated using logistic analyses.
Data from 293 patients with confirmed BSI were included; 242 (82.6%) patients had CRAB BSI and 51 (17.4%) patients had non-CRAB BSI. Risk factors significantly associated with CRAB BSI were a previous intensive care unit (ICU) stay (=0.029), cefoperazone-sulbactam use (=0.030), and carbapenem use (=0.004). Among 236 patients with BSI who were evaluable at 28 days after receiving antibacterial therapy, there were 86 deaths. Factors associated with the 28-day mortality were ICU stay after BSI (=0.040), readmission within 90 days (=0.029), Acute Physiology and Chronic Health Evaluation II (APACHE II) score at diagnosis >19 (=0.012), tigecycline therapy (=0.021), presence of septic shock (=0.029), and multiple organ failure (=0.016). Death rates in patients treated with tigecycline were 53.5% vs 24.1% in patients treated with other agents. Among 186 patients with CRAB BSI evaluable at 28 days, 84 patients died. The associated risk factors were an ICU stay after BSI (=0.036), APACHE II score >19 at diagnosis ( = 0.002), presence of septic shock (=0.030), and multiple organ failure (=0.007).
This study demonstrated that an ICU stay and cefoperazone-sulbactam or carbapenem use were seen to be the risk factors associated with the development of CRAB BSI. Critical illness and tigecycline therapy were significantly associated with higher mortality of patients with BSI.
耐碳青霉烯类鲍曼不动杆菌（CRAB）是一种迅速出现的、危及生命的医院感染。本研究旨在探讨CRAB血流感染（BSI）的危险因素、临床特征、抗菌治疗及转归。
这是一项对2012年至2015年在一家三级教学医院接受治疗的BSI患者数据进行的回顾性比较分析。采用逻辑分析评估与CRAB BSI相关的危险因素以及与28天死亡率相关的因素。
纳入293例确诊BSI患者的数据；242例（82.6%）患者为CRAB BSI，51例（17.4%）患者为非CRAB BSI。与CRAB BSI显著相关的危险因素为既往入住重症监护病房（ICU）（=0.029）、使用头孢哌酮 - 舒巴坦（=0.030）和使用碳青霉烯类药物（=0.004）。在236例接受抗菌治疗后28天可评估的BSI患者中，有86例死亡。与28天死亡率相关的因素为BSI后入住ICU（=0.040）、90天内再次入院（=0.029）、诊断时急性生理与慢性健康状况评分系统II（APACHE II）>19（=0.012）、使用替加环素治疗（=0.021）、存在感染性休克（=0.029）和多器官功能衰竭（=0.016）。接受替加环素治疗的患者死亡率为53.5%，而接受其他药物治疗的患者死亡率为24.1%。在28天可评估的186例CRAB BSI患者中，84例死亡。相关危险因素为BSI后入住ICU（=0.036）、诊断时APACHE II>19（=0.002）、存在感染性休克（=0.030）和多器官功能衰竭（=0.007）。
本研究表明，入住ICU以及使用头孢哌酮 - 舒巴坦或碳青霉烯类药物被视为与CRAB BSI发生相关的危险因素。危重病和替加环素治疗与BSI患者较高的死亡率显著相关。
