1State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Department of Respiratory medicine, Ningbo Medical Treatment Center Li huili Hospital, Ningbo, People's Republic of China.
Antimicrob Resist Infect Control. 2019 Apr 25;8:68. doi: 10.1186/s13756-019-0520-8. eCollection 2019.
(PA) is a leading cause of nosocomial infections, and carbapenem non-susceptible strains are a major threat to patient safety.
A single center, retrospective comparative analysis of carbapenem-non-susceptible PA (CnSPA) and carbapenem-susceptible PA (CSPA) bloodstream infections (BSIs) was conducted between January 1, 2007, and December 31, 2016. Prevalence and risk factors associated with CnSPA BSIs were examined.
The study enrolled 340 patients with PA BSIs; 30.0% ( = 101) of patients had CnSPA. High APACHE II scores (≥15), central venous catheterization, and delayed application of appropriate definitive therapy were independently associated with higher risk of mortality in PA BSIs. Multivariate analysis revealed that respiratory disease and exposure to carbapenems within the previous 90 days to onset of BSI were independent risk factors for acquisition of CnSPA BSIs. Overall all-cause 30-day mortality associated with PA BSIs was 26.8% (91/340). In addition, mortality was higher in patients with CnSPA than in those with CSPA (37.6% vs. 22.2%, respectively; = 0.003). Corticosteroid therapy and delayed receipt of effective definitive therapy were independent risk factors for death from CnSPA BSIs.
Increased incidence of CnSPA BSIs was observed during the study period, with higher mortality seen in patients with these infections. Respiratory disease and exposure to carbapenems were independent risk factors for development of CnSPA BSIs. Appropriate definitive therapy reduced mortality rates. BLBLIs were as effective as carbapenems as a treatment for PA BSIs.
（鲍曼不动杆菌）是医院获得性感染的主要原因，而对碳青霉烯类药物不敏感的菌株对患者安全构成重大威胁。
本研究于 2007 年 1 月 1 日至 2016 年 12 月 31 日进行了一项单中心、回顾性比较分析，比较了耐碳青霉烯鲍曼不动杆菌（CnSPA）和碳青霉烯敏感鲍曼不动杆菌（CSPA）血流感染（BSI）。研究检查了 CnSPA BSI 的流行情况和相关危险因素。
本研究纳入了 340 例鲍曼不动杆菌 BSI 患者；30.0%（101 例）患者为 CnSPA。高急性生理与慢性健康状况评分 II （APACHE II）评分（≥15）、中心静脉导管置管和延迟应用适当的确定性治疗与鲍曼不动杆菌 BSI 患者死亡率升高独立相关。多变量分析显示，呼吸疾病和在 BSI 发病前 90 天内接触碳青霉烯类药物是获得 CnSPA BSI 的独立危险因素。总体而言，鲍曼不动杆菌 BSI 相关的全因 30 天死亡率为 26.8%（91/340）。此外，CnSPA 患者的死亡率高于 CSPA 患者（分别为 37.6%和 22.2%；=0.003）。皮质类固醇治疗和延迟接受有效确定性治疗是 CnSPA BSI 死亡的独立危险因素。
在研究期间，CnSPA BSI 的发病率增加，感染这些细菌的患者死亡率更高。呼吸疾病和接触碳青霉烯类药物是 CnSPA BSI 发生的独立危险因素。适当的确定性治疗降低了死亡率。BLBLIs 与碳青霉烯类药物一样，可有效治疗鲍曼不动杆菌 BSI。
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