Carvalho Ana Sofia, Lagana Diana, Catford Jennifer, Shaw David, Bak Narin
Infectious Diseases Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia.
Infection and Prevention Control Unit, Royal Adelaide Hospital (RAH), Adelaide, Australia.
Infect Dis Health. 2020 Feb;25(1):22-29. doi: 10.1016/j.idh.2019.08.006. Epub 2019 Oct 2.
Patients with haematological malignancies have higher risk of acquiring bloodstream infection (BSI). Neutropenia resulting from cytotoxic chemotherapy is the most common risk factor. Infections can progress rapidly with poor outcomes. Understanding the epidemiology may enable prevention and effective management. We investigated and compared the incidence of BSI amongst patients with haematological malignancies and neutropenia and examined the changing spectrum of organisms, and their antimicrobial profiles.
BSI data between July 1st 2009 and June 30th 2015 was reviewed.
Three hundred and fifty five BSI were identified in 255 neutropenic patients. Acute myeloid leukaemia (AML) accounted for 40%, Non-Hodgkin's lymphoma for 22% and Acute lymphocytic leukaemia (ALL) for 11.8%. A neutrophil count of <500 cells/μL was present in 93.2%. The overall incidence was 5.40 BSI per 1000 Haematology Occupied Bed days (OBD). Viridans streptococci and Enterococcus species were the most predominant Gram-positives. Vancomycin resistant Enterococcus faecium (VRE) emerged as the predominant Enterococcus species during the study period. Escherichia coli was the most predominant Gram-negative and Extended-spectrum beta-lactamases (ESBL) were detected in 7.1% of isolates. Amongst the Enterobacteriaceae and Pseudomonas aeruginosa dual resistance to Piperacillin-tazobactam and Gentamicin was detected in 5.4%.
Our incidence of BSI was 5.40 per 1000 OBD, however variability in reporting of rates in neutropenic patients with haematological malignancies makes comparison between studies difficult, highlighting the need for rate reporting standardization. The epidemiology of organisms causing BSI has changed over time. There is a trend towards an increasing incidence of VRE and multidrug resistant Gram-negatives.
血液系统恶性肿瘤患者发生血流感染（BSI）的风险较高。细胞毒性化疗导致的中性粒细胞减少是最常见的危险因素。感染进展迅速，预后较差。了解流行病学情况有助于预防和有效管理。我们调查并比较了血液系统恶性肿瘤合并中性粒细胞减少患者中BSI的发生率，研究了病原体谱的变化及其抗菌谱。
回顾了2009年7月1日至2015年6月30日期间的BSI数据。
在255例中性粒细胞减少患者中识别出355例BSI。急性髓系白血病（AML）占40%，非霍奇金淋巴瘤占22%，急性淋巴细胞白血病（ALL）占11.8%。93.2%的患者中性粒细胞计数<500个细胞/μL。总体发生率为每1000个血液科占用床日（OBD）发生5.40例BSI。草绿色链球菌和肠球菌是最主要的革兰氏阳性菌。在研究期间，耐万古霉素屎肠球菌（VRE）成为主要的肠球菌种类。大肠埃希菌是最主要的革兰氏阴性菌，7.1%的分离株检测到超广谱β-内酰胺酶（ESBL）。在肠杆菌科和铜绿假单胞菌中，5.4%的菌株对哌拉西林-他唑巴坦和庆大霉素呈现双重耐药。
我们的BSI发生率为每1000个OBD发生5.40例，然而血液系统恶性肿瘤合并中性粒细胞减少患者感染率报告的差异使得不同研究之间难以比较，凸显了感染率报告标准化的必要性。导致BSI的病原体流行病学情况随时间发生了变化。VRE和多重耐药革兰氏阴性菌的发生率有上升趋势。
