Department of Infectious Diseases, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel.
Division of Internal Medicine D, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel.
Int J Antimicrob Agents. 2019 Apr;53(4):423-428. doi: 10.1016/j.ijantimicag.2018.12.003. Epub 2018 Dec 17.
Patients with neutropenia are vulnerable to serious infections. During the last decade, increased prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae has affected immunocompromised patients. We conducted a single-center case-control study to evaluate factors associated with ESBL-positive bacteremia among neutropenic patients, and its clinical impact. The study included adult patients with hematologic or oncologic diseases diagnosed with ESBL-positive and ESBL-negative Escherichia coli or Klebsiella pneumoniae bacteremia during febrile neutropenia between January 2010 and October 2017 at the Shaare Zedek Medical Center, Jerusalem, Israel. Analyses included risk factors for ESBL-positive bacteremia, appropriateness of empiric antibiotics, mortality, length of stay, and intensive care unit (ICU) admission. Univariate and multivariate models were constructed. The cohort (80 patients), consisted of 54 ESBL-negative and 26 ESBL-positive Gram-negative bacteremia. Multivariate analysis suggested ESBL-positive bacteremia to be associated with long-term central venous catheter (CVC) (odds ratio (OR), 8.7; 95% confidence interval (CI), 1.6-48.1; P=0.01], index culture obtained 48 h post-admission (OR, 3.6; 95% CI, 1-12.3; P=0.04), and exposure to previous antimicrobial therapy (OR, 12.6; 95% CI, 2.1-74; P<0.01). There were no significant differences between groups with regard to length of stay, ICU admission, or mortality rates. Mortality was associated with high Pitt bacteremia score but not inappropriate empirical therapy. Previous antimicrobial therapy, long-term CVC, and hospital-acquired bacteremia were associated with ESBL bacteremia. Neutropenic patients with ESBL bacteremia have increased morality due to other factors than ESBL status. These findings should be validated in other centers and with larger populations.
中性粒细胞减少症患者易发生严重感染。在过去十年中，产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌的流行率增加，影响了免疫功能低下的患者。我们进行了一项单中心病例对照研究，以评估中性粒细胞减少症患者中 ESBL 阳性菌血症的相关因素及其临床影响。该研究纳入了 2010 年 1 月至 2017 年 10 月期间在以色列耶路撒冷的 Shaare Zedek 医疗中心因发热性中性粒细胞减少症而诊断为产 ESBL 阳性大肠埃希菌或肺炎克雷伯菌菌血症的血液或肿瘤疾病的成年患者。分析包括 ESBL 阳性菌血症的危险因素、经验性抗生素的适当性、死亡率、住院时间和重症监护病房（ICU）入住率。进行了单变量和多变量模型构建。该队列（80 例患者）包括 54 例 ESBL 阴性和 26 例 ESBL 阳性革兰氏阴性菌血症。多变量分析表明，ESBL 阳性菌血症与长期中心静脉导管（CVC）（比值比（OR），8.7；95%置信区间（CI），1.6-48.1；P=0.01）、入院后 48 小时获得的指数培养物（OR，3.6；95%CI，1-12.3；P=0.04）和先前暴露于抗菌治疗（OR，12.6；95%CI，2.1-74；P<0.01）相关。两组在住院时间、入住 ICU 或死亡率方面无显著差异。死亡率与高 Pitt 菌血症评分相关，但与经验性治疗不当无关。先前的抗菌治疗、长期 CVC 和医院获得性菌血症与 ESBL 菌血症相关。ESBL 菌血症的中性粒细胞减少症患者的死亡率增加是由于 ESBL 状态以外的其他因素。这些发现应在其他中心和更大的人群中得到验证。
