Wei J, Zhu Q L, Sun Z, Wang C
Department of Hematology, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China.
Department of Nosocomial Infection Control, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.
Zhonghua Nei Ke Za Zhi. 2020 May 1;59(5):353-359. doi: 10.3760/cma.j.cn112138-20191104-00728.
To assess the risk factors for mortality and clinical outcome of carbapenem-resistant (CRPA) infections in patients with hematological disorders. The data of in-patients with hematological disorders infected by CRPA or carbapenem-susceptible (CSPA) were recorded in a seven-year retrospective cohort study. Risk factors for CRPA infections and impact of on mortality were identified. The primary end point was 30-day all-cause mortality. A total of 81 patients with PA infections were included in the study, including 58 CSPA and 23 CRPA. Most of the primary diseases were acute leukemia or lymphoma (79.0%, 64/81). The median absolute neutrophil count at infection onset was 0.24×10(9)/L. Independent risk factors associated with carbapenem-resistance included longer duration of hospital stay (=0.013, =1.045) and carbapenem exposure one month prior to infections (=0.005, =8.132). The 30-day all-cause mortality of the whole cohort was 29.6%(24/81), and 30-day attributable mortality was 13.6%(11/81). Pulmonary infection was the leading cause of death, accounting for 41.7%(10/24). The adjusted 30-day mortality rate was significantly higher in patients with CRPA compared with CSPA [60.9%(14/23) vs. 17.2%(10/58), <0.001, respectively]. CRPA infection was an independent prognostic factor for 30-day mortality(=0.011, =5.427). Other factors included old age, longer duration of neutropenia and poor functional performance. Patients with hematological disorders have high mortality rate and poor prognosis caused by CRPA infections, which mainly develop in lungs.
评估血液系统疾病患者碳青霉烯类耐药肺炎克雷伯菌（CRPA）感染的死亡风险因素及临床结局。在一项为期7年的回顾性队列研究中，记录了CRPA感染或碳青霉烯类敏感肺炎克雷伯菌（CSPA）感染的血液系统疾病住院患者的数据。确定CRPA感染的风险因素及其对死亡率的影响。主要终点是30天全因死亡率。该研究共纳入81例肺炎克雷伯菌感染患者，其中58例为CSPA感染，23例为CRPA感染。大多数原发性疾病为急性白血病或淋巴瘤（79.0%，64/81）。感染开始时的中性粒细胞绝对计数中位数为0.24×10⁹/L。与碳青霉烯类耐药相关的独立风险因素包括住院时间延长（P = 0.013，HR = 1.045）和感染前1个月的碳青霉烯类暴露（P = 0.005，HR = 8.132）。整个队列的30天全因死亡率为29.6%（24/81），30天归因死亡率为13.6%（11/81）。肺部感染是主要死因，占41.7%（10/24）。与CSPA患者相比，CRPA患者的校正30天死亡率显著更高[分别为60.9%（14/23）和17.2%（10/58），P<0.001]。CRPA感染是30天死亡率的独立预后因素（P = 0.011，HR = 5.427）。其他因素包括老年、中性粒细胞减少持续时间延长和功能状态差。血液系统疾病患者因CRPA感染导致的死亡率高且预后差，主要发生在肺部。
