Vinker-Shuster Michal, Stepensky Polina, Temper Violeta, Shayovitz Vered, Masarwa Reem, Averbuch Diana
Pediatric Infectious Diseases Unit.
Departments of Stem Cell Transplantation.
J Pediatr Hematol Oncol. 2019 Nov;41(8):e493-e498. doi: 10.1097/MPH.0000000000001556.
Gram-negative rod (GNR) infections adversely affect the outcome of patients with malignancies and following hematopoietic stem cell transplantation (HSCT). This retrospective observational study aimed to describe the epidemiology, outcome, and resistance patterns of GNR bacteremia in children with hematologic malignancies (HM) and after HSCT during the period spanning from 2010 to 2014 in a tertiary children's hospital. A total of 270 children were included in the analysis; 65 (24%) developed 85 episodes of GNR bacteremia; the rate was 36/122 (29.5%) in post-HSCT and 29/178 (16.3%) in HM patients (P<0.05). Overall, 10% of the GNRs were carbapenem resistant. In multivariate analysis, prolonged neutropenia (≥7 d; odds ratio: 19.5, 95% confidence interval: 2.6-148.4) and total hospitalization for a duration of >30 days in the last 3 months (odds ratio: 17.5, 95% confidence interval: 1.4-224.4) were associated with carbapenem-resistant GNR bacteremia. Thirty-day mortality following GNR bacteremia was 0% in HM and 7/52 episodes (13.5%) in HSCT patients (P<0.05). Carbapenem-resistant versus carbapenem-sensitive bacteremia was associated with longer duration of bacteremia (mean: 3.8 vs. 1.7 d), higher risk for intensive care unit hospitalization (44.4% vs. 10.1%), and higher mortality rate (33% vs. 5.8%) (P<0.05). To summarize, GNR bacteremia was frequent, especially in post-HSCT children. Carbapenem resistance adversely affects patients' outcome, increasing morbidity and mortality. Empirical antibiotic therapy must be adjusted to the local resistance patterns.
革兰氏阴性杆菌（GNR）感染会对恶性肿瘤患者以及造血干细胞移植（HSCT）后的患者预后产生不利影响。这项回顾性观察性研究旨在描述2010年至2014年期间，一家三级儿童医院中患有血液系统恶性肿瘤（HM）的儿童以及HSCT后发生GNR菌血症的流行病学、预后及耐药模式。共有270名儿童纳入分析；65名（24%）发生了85次GNR菌血症发作；HSCT后发生率为36/122（29.5%），HM患者中为29/178（16.3%）（P<0.05）。总体而言，10%的GNR对碳青霉烯耐药。多因素分析显示，长期中性粒细胞减少（≥7天；比值比：19.5，95%置信区间：2.6-148.4）以及过去3个月内总住院时间>30天（比值比：17.5，95%置信区间：1.4-224.4）与碳青霉烯耐药GNR菌血症相关。GNR菌血症后30天死亡率在HM患者中为0%，HSCT患者中为7/52次发作（13.5%）（P<0.05）。碳青霉烯耐药菌血症与碳青霉烯敏感菌血症相比，菌血症持续时间更长（平均：3.8天对1.7天）、入住重症监护病房风险更高（44.4%对10.1%）以及死亡率更高（33%对5.8%）（P<0.05）。总之，GNR菌血症很常见，尤其是在HSCT后的儿童中。碳青霉烯耐药会对患者预后产生不利影响，增加发病率和死亡率。经验性抗生素治疗必须根据当地耐药模式进行调整。
