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血液恶性肿瘤患者菌血症死亡的危险因素 - 一项回顾性研究。

Risk factors for mortality due to bacteremia in patients with hematological malignancies - a retrospective study.

机构信息

Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.

Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

Leuk Lymphoma. 2019 Nov;60(11):2787-2792. doi: 10.1080/10428194.2019.1599113. Epub 2019 Apr 24.

Abstract

Carbapenem resistant (CRAB) is a significant cause of hospital acquired bloodstream infections in patients with hematological malignancies. Data regarding outcomes in this group of patients are limited. We retrospectively analyzed mortality risk factors of hospitalized hematological patients with CRAB bacteremia in our center. Among 46 included patients, overall 7-day mortality was 72% (33/46). Risk factors for 7-day mortality in multivariate analysis were higher infection severity score (SOFA score) at presentation (OR 1.481, 95% CI 1.091-2.012,  = .012) while appropriate antibiotic therapy within 48 h was protective (OR 0.052, 95% CI 0.005-0.590,  = .017). Inappropriate antibiotic therapy within 24 h was not significantly associated with 7-day mortality nor was absolute neutrophil count. Thirty-day mortality was 96% (44/46). CRAB bacteremia in hematological patients is associated with extremely high mortality, regardless of therapy. Infection control measures and antimicrobial stewardship aiming to prevent this infection of dismal prognosis are of major importance.

摘要

耐碳青霉烯类抗生素的(CRAB)是血液恶性肿瘤患者获得性血流感染的重要原因。关于这组患者结局的数据有限。我们回顾性分析了我院血液科耐碳青霉烯类抗生素血流感染住院患者的死亡危险因素。在纳入的 46 例患者中,总体 7 天死亡率为 72%(33/46)。多因素分析中,7 天死亡率的危险因素是就诊时更高的感染严重程度评分(SOFA 评分)(OR 1.481,95%CI 1.091-2.012,=0.012),而在 48 小时内给予适当的抗生素治疗具有保护作用(OR 0.052,95%CI 0.005-0.590,=0.017)。24 小时内给予不适当的抗生素治疗与 7 天死亡率无关,与绝对中性粒细胞计数也无关。30 天死亡率为 96%(44/46)。血液科患者发生 CRAB 菌血症与极高的死亡率相关,无论治疗如何。感染控制措施和旨在预防这种预后不良感染的抗菌药物管理非常重要。

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