不同造血干细胞移植患者中耐碳青霉烯类肠杆菌科细菌的筛查频率：哪种更好？
Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?
机构信息
Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
Institute of Hematology, Zhejiang University, Hangzhou, China.
出版信息
Antimicrob Resist Infect Control. 2020 Mar 17;9(1):49. doi: 10.1186/s13756-020-0706-0.
BACKGROUND
A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI).
METHODS
We retrospectively studied the clinical data of 395 consecutive HSCT patients from September 2017 to April 2019. From September 2017 to June 2018 (period 1), 200 patients received single CRE screening before transplantation. From July 2018 to April 2019 (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary.
RESULTS
During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P < 0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 h of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 h after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 h after fever onset and died of septic shock.
CONCLUSION
The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.
背景
已有共识认为，对免疫抑制个体进行碳青霉烯类耐药肠杆菌科（CRE）筛查可以降低 CRE 血流感染（BSI）的发生率。
方法
我们回顾性研究了 2017 年 9 月至 2019 年 4 月期间连续 395 例 HSCT 患者的临床数据。2017 年 9 月至 2018 年 6 月（第 1 期），200 例患者在移植前接受单次 CRE 筛查。2018 年 7 月至 2019 年 4 月（第 2 期），195 例患者入院后每周接受连续 CRE 筛查。对于 CRE 定植的患者，给予以下靶向管理：（1）接触预防措施，（2）必要时进行抢先的 CRE 靶向治疗。
结果
第 1 期共检出 3 例 CRE 定植患者（1.5%）。CRE BSI 发生率为 2.0%（4 例），相关 30 天死亡率为 50.0%（4 例中的 2 例）。第 2 期共检出 21 例 CRE 定植患者，检出率明显高于第 1 期（P<0.001）。21 例定植患者中，4 例（19.0%）在首次筛查时即 CRE 阳性，5 例（23.8%）在第二次筛查时阳性，其余 12 例（57.1%）在第三次或后续筛查时阳性。CRE BSI 发生率降至 0.5%（1/195），且无 CRE 相关死亡。15 例定植患者出现中性粒细胞减少性发热。13 例定植患者发热后 24 小时内预防性使用替加环素，迅速控制体温。1 例定植患者发热后 48 小时内使用替加环素，因加用多粘菌素而存活。另 1 例定植患者发热后 72 小时内使用替加环素，死于感染性休克。
结论
增加筛查频率有助于检出 CRE 定植患者。对这些定植患者进行靶向管理可能有助于降低 CRE BSI 的发生率和死亡率，从而改善患者预后。
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