State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Clin Infect Dis. 2020 Dec 23;71(Suppl 4):S386-S393. doi: 10.1093/cid/ciaa1522.
Pseudomonas aeruginosa (PA) bloodstream infection (BSI) is a common complication in patients with acute leukemia (AL), and the prevalence of antibiotic-resistant strains poses a serious problem. However, there is limited information regarding antibiotic resistance, clinical characteristics, and outcomes of PA BSI in AL patients. This study explored characteristics associated with the clinical outcomes of AL patients with PA BSI and analyzed factors associated with BSI caused by multidrug-resistant (MDR) or carbapenem-resistant strains.
This single-center retrospective study enrolled hospitalized AL patients who developed PA BSI during January 2014-December 2019. The Kaplan-Meier method was used to plot survival curves. Multivariate logistic regression analyses were also performed.
Of 293 eligible patients with PA BSI, 55 (18.8%) received inappropriate empirical antibiotic therapy within 48 hours of BSI onset, whereas up to 65.8% MDR-PA BSI patients received inappropriate empirical treatment. The 30-day mortality rate was 8.5% for all patients. However, the 30-day mortality rates were 28.9% and 5.5% in MDR-PA BSI and non-MDR-PA BSI patients, respectively (P < .001). On multivariate analysis, previous use of quinolones (odds ratio [OR], 5.851 [95% confidence interval {CI}, 2.638-12.975]) and piperacillin/tazobactam (OR, 2.837 [95% CI, 1.151-6.994]) were independently associated with MDR-PA BSI; and MDR-PA BSI (OR, 7.196 [95% CI, 2.773-18.668]), perianal infection (OR, 4.079 [95% CI, 1.401-11.879]), pulmonary infection (OR, 3.028 [95% CI, 1.231-7.446]), and age ≥55 years (OR, 2.871 [95% CI, 1.057-7.799]) were independent risk factors for 30-day mortality.
MDR increases mortality risk in PA BSI patients, and previous antibiotic exposure is important in MDR-PA BSI development. Rational antibiotic use based on local antimicrobial susceptibility and clinical characteristics can help reduce antibiotic resistance and mortality.
铜绿假单胞菌（PA）血流感染（BSI）是急性白血病（AL）患者的常见并发症，且抗生素耐药株的流行是一个严重的问题。然而，关于 AL 患者 PA BSI 的抗生素耐药性、临床特征和转归的信息有限。本研究探讨了与 AL 患者 PA BSI 临床转归相关的特征，并分析了多药耐药（MDR）或碳青霉烯耐药菌株引起 BSI 的相关因素。
这是一项单中心回顾性研究，纳入了 2014 年 1 月至 2019 年 12 月期间发生 PA BSI 的住院 AL 患者。采用 Kaplan-Meier 法绘制生存曲线。还进行了多变量逻辑回归分析。
在 293 例符合条件的 PA BSI 患者中，有 55 例（18.8%）在 BSI 发病后 48 小时内接受了不适当的经验性抗生素治疗，而多达 65.8%的 MDR-PA BSI 患者接受了不适当的经验性治疗。所有患者的 30 天死亡率为 8.5%。然而，MDR-PA BSI 和非 MDR-PA BSI 患者的 30 天死亡率分别为 28.9%和 5.5%（P<0.001）。多变量分析显示，既往使用喹诺酮类药物（比值比[OR]，5.851[95%置信区间{CI}，2.638-12.975]）和哌拉西林/他唑巴坦（OR，2.837[95%CI，1.151-6.994]）与 MDR-PA BSI 独立相关；MDR-PA BSI（OR，7.196[95%CI，2.773-18.668]）、肛周感染（OR，4.079[95%CI，1.401-11.879]）、肺部感染（OR，3.028[95%CI，1.231-7.446]）和年龄≥55 岁（OR，2.871[95%CI，1.057-7.799]）是 30 天死亡率的独立危险因素。
MDR 增加了 PA BSI 患者的死亡风险，既往抗生素暴露是 MDR-PA BSI 发生的重要因素。基于当地抗菌药物敏感性和临床特征的合理抗生素使用有助于减少抗生素耐药性和死亡率。
