Department of Medicine, Hematology/Oncology, Goethe University Hospital, Frankfurt/Main, Germany.
University Cancer Center Frankfurt (UCT), Goethe University Hospital, Frankfurt/Main, Germany.
PLoS One. 2019 Jan 23;14(1):e0210991. doi: 10.1371/journal.pone.0210991. eCollection 2019.
The global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodeficiency are especially at risk for fatal infections caused by MDRO. The impact of MDRO colonization on the clinical course of AML patients undergoing intensive induction chemotherapy-a potentially curative but highly toxic treatment option-has not been systematically studied.
MATERIALS & METHODS: 312 AML patients undergoing intensive induction chemotherapy between 2007 and 2015 were examined for MDRO colonization. Patients with evidence for MDRO before or during the hospital stay of induction chemotherapy were defined as colonized, patients who never had a positive swab for MDRO were defined as noncolonized.
Of 312 AML patients 90 were colonized and 130 were noncolonized. Colonized patients suffered from significantly more days with fever, spent more days on the intensive care unit and had a higher median C-reactive protein value during the hospital stay. These findings did not result in a prolonged length of hospital stay or an increased mortality rate for colonized patients. However, in a subgroup analysis, patients colonized with carbapenem-resistant enterobacteriaceae (CRE) had a significantly reduced 60- and 90-day, as well as 1- and 2-year survival rates when compared to noncolonized patients.
Our analysis highlights the importance of intensive MDRO screening especially in patients with febrile neutropenia since persisting fever can be a sign of MDRO-colonization. CRE-colonized patients require special surveillance, since they seem to be at risk for death.
多药耐药菌（MDRO）在全球范围内的传播使医院的治疗和隔离措施变得复杂，并已证明会增加死亡率。患有疾病或治疗相关免疫功能低下的患者特别容易受到 MDRO 引起的致命感染。MDRO 定植对接受强化诱导化疗的 AML 患者的临床病程的影响尚未得到系统研究，强化诱导化疗是一种潜在的治愈但毒性很高的治疗选择。
我们对 2007 年至 2015 年间接受强化诱导化疗的 312 例 AML 患者进行了 MDRO 定植检测。在诱导化疗住院前或住院期间有 MDRO 证据的患者被定义为定植，从未有 MDRO 阳性拭子的患者被定义为未定植。
312 例 AML 患者中，90 例定植，130 例未定植。定植患者发热天数明显增多，入住重症监护病房天数增多，住院期间 C 反应蛋白中位数升高。这些发现并未导致定植患者的住院时间延长或死亡率增加。然而，在亚组分析中，与未定植患者相比，定植碳青霉烯耐药肠杆菌科细菌（CRE）的患者 60 天和 90 天、1 年和 2 年的生存率显著降低。
我们的分析强调了对 MDRO 进行强化筛查的重要性，尤其是对发热性中性粒细胞减少症患者，因为持续发热可能是 MDRO 定植的迹象。CRE 定植患者需要特殊监测，因为他们似乎有死亡风险。
