Liu Keh-Sen, Tong Yao-Shen, Lee Ming-Tsung, Lin Hung-Yu, Lu Min-Chi
Division of Infectious Diseases, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
Department of Medical Laboratory, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
J Pers Med. 2021 Jun 29;11(7):616. doi: 10.3390/jpm11070616.
An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, < 0.001), platelet count (per 1 × 10/mm, adjusted HR = 0.95, = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.
目前尚无用于治疗耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染（BSI）患者的最佳抗菌方案。本研究旨在确定CRKP BSI患者的合适抗生素及全因死亡率的危险因素。这项回顾性队列研究纳入了住院的CRKP BSI患者。主要结局是30天全因死亡率。采用Cox回归分析评估30天死亡率的危险因素。共纳入89例患者，30天死亡率为52.1%。共有52例（58.4%）患者接受了合适的抗菌方案治疗，58株（65.2%）分离株携带基因。7天内微生物清除（调整后风险比[HR]=0.09，<0.001）、血小板计数（每1×10/mm，调整后HR=0.95，=0.002）和皮特菌血症评分（调整后HR=1.40，<0.001）与30天全因死亡率独立相关。未确定有效的抗菌方案。总之，CRKP BSI患者30天死亡率的危险因素包括微生物清除>7天、血小板计数较低和皮特菌血症评分较高。这些发现为CRKP BSI的临床情况提供了新的见解。
