Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
Intravenous Therapy Team, Instituto Nacional de Cancerología, Mexico City, Mexico.
Am J Infect Control. 2020 Jan;48(1):40-45. doi: 10.1016/j.ajic.2019.06.008. Epub 2019 Aug 5.
Central venous catheters (CVCs) are essential for treating cancer patients, but infection is a risk associated with their use, particularly by multidrug-resistant (MDR) bacteria. The aim of this study was to describe the microbiology of catheter-related bloodstream infections (CRBSIs) in cancer patients and to compare the prevalence of MDR ESKAPE microorganisms (Enterococcus faecium, Staphylococcus spp, Klebsiella spp, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) plus Escherichia coli (ESKAPE).
Based on data from 2013 to 2015 from a prospective survey of CRBSIs by the intravenous therapy team, we describe the microbiology and compare the prevalence of MDR ESKAPE strains between hospitalized patients and outpatients.
A total of 469 episodes of CRBSI were diagnosed: 261 (62%) were in women; 87 (18.6%) occurred in hospitalized patients, and 382 (81.4%) in ambulatory patients; 27.5% of patients had a hematologic malignancy and 72.5% a solid tumor. The median time between CVC insertion and CRBSI was 116 days (interquartile range [IQR], 48-207). The most common bacteria isolated were Staphylococcus epidermidis (18.1%), S aureus (10.9%), E coli (7.7%), and Klebsiella spp (8.6%). ESKAPE accounted for 35.6%. Methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 16.4; 95% confidence interval [CI], 1.6-114; P = .01), extended-spectrum beta-lactamase (ESBL) Klebsiella spp (OR, 26; 95% CI, 2-286; P = .007), and ESBL E coli (OR, 26; 95% CI, 2-286; P = .007) were significantly more frequently isolated from hospitalized vs ambulatory patients.
MRSA, ESBL E. coli and ESBL Klebsiella spp were significantly more frequently isolated from hospitalized patients with CRBSI.
中心静脉导管（CVC）是治疗癌症患者的重要手段，但使用 CVC 会增加感染风险，尤其是由多重耐药（MDR）细菌引起的感染。本研究旨在描述癌症患者中心静脉相关血流感染（CRBSI）的微生物学特征，并比较耐多药 ESKAPE 微生物（屎肠球菌、葡萄球菌属、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和阴沟肠杆菌）和大肠埃希菌（ESKAPE）的流行率。
根据静脉治疗小组 2013 年至 2015 年对 CRBSI 的前瞻性调查数据，我们描述了微生物学特征，并比较了住院患者和门诊患者中 MDR ESKAPE 菌株的流行率。
共诊断出 469 例 CRBSI：261 例（62%）为女性；87 例（18.6%）发生于住院患者，382 例（81.4%）发生于门诊患者；27.5%的患者患有血液系统恶性肿瘤，72.5%的患者患有实体肿瘤。CVC 置入与 CRBSI 之间的中位时间为 116 天（四分位距[IQR]，48-207）。分离出的最常见细菌为表皮葡萄球菌（18.1%）、金黄色葡萄球菌（10.9%）、大肠埃希菌（7.7%）和肺炎克雷伯菌属（8.6%）。ESKAPE 占 35.6%。耐甲氧西林金黄色葡萄球菌（MRSA）（比值比[OR]，16.4；95%置信区间[CI]，1.6-114；P=0.01）、产超广谱β-内酰胺酶（ESBL）肺炎克雷伯菌属（OR，26；95%CI，2-286；P=0.007）和产 ESBL 大肠埃希菌（OR，26；95%CI，2-286；P=0.007）在住院患者中分离率显著高于门诊患者。
MRSA、ESBL 大肠埃希菌和 ESBL 肺炎克雷伯菌属在住院 CRBSI 患者中分离率显著更高。
