Department of Medicine, Gastroenterology, Hepatology and Endocrinology, Goethe University Frankfurt, Frankfurt/Main, Germany.
University Cancer Center, Goethe University Hospital, Frankfurt/Main, Germany.
J Cancer Res Clin Oncol. 2022 Jun;148(6):1465-1472. doi: 10.1007/s00432-021-03741-0. Epub 2021 Jul 20.
MDRO-colonization has been shown to impair survival in patients with hematological malignancies and solid tumors as well as in patients with liver disease. Despite the increasing spread of multidrug-resistant organisms (MDRO), its impact on patients with hepatocellular carcinoma (HCC) has not been studied. We conducted this retrospective study to analyze the impact of MDRO-colonization on overall prognosis in HCC patients.
All patients with confirmed HCC diagnosed between January 2008 and December 2017 at the University Hospital Frankfurt were included in this study. HCC patients with a positive MDRO screening before or within the first 90 days after diagnosis of HCC were defined as colonized HCC patients, HCC patients with a negative MDRO screening were defined as noncolonized HCC patients.
59 (6%) colonized and 895 (94%) noncolonized HCC patients were included. Enterobacterales with extended-spectrum β-lactamase-like phenotype with or without resistance to fluoroquinolones (ESBL/ ± FQ) were the most frequently found MDRO with 59%, followed by vancomycin-resistant Enterococcus faecium with 37%. Colonized HCC patients had more severe cirrhosis and more advanced HCC stage compared to noncolonized HCC patients. Colonized HCC patients showed an impaired survival with a median OS of 189 days (6.3 months) compared to a median OS of 1001 days (33.4 months) in noncolonized HCC patients. MDRO-colonization was identified as an independent risk factor associated with survival in multivariate analysis.
MDRO-colonization is an independent risk factor for survival in patients with HCC highlighting the importance of regular MDRO screening, isolation measures as well as interdisciplinary antibiotic steward-ship programs to guide responsible use of antibiotic agents.
耐多药菌定植已被证明会降低血液系统恶性肿瘤和实体瘤患者以及肝病患者的生存率。尽管多药耐药菌（MDRO）的传播不断增加，但尚未研究其对肝细胞癌（HCC）患者的影响。我们进行了这项回顾性研究，以分析 MDRO 定植对 HCC 患者总体预后的影响。
本研究纳入了 2008 年 1 月至 2017 年 12 月期间在法兰克福大学医院确诊的所有 HCC 患者。在 HCC 诊断前或诊断后 90 天内 MDRO 筛查阳性的 HCC 患者被定义为 MDRO 定植 HCC 患者，MDRO 筛查阴性的 HCC 患者被定义为非 MDRO 定植 HCC 患者。
共纳入 59 例 MDRO 定植 HCC 患者（6%）和 895 例非 MDRO 定植 HCC 患者。产超广谱β-内酰胺酶（ESBL）/±氟喹诺酮类耐药的肠杆菌科（ESBL/±FQ）最常见，占 59%，其次是万古霉素耐药粪肠球菌（VRE），占 37%。与非 MDRO 定植 HCC 患者相比，MDRO 定植 HCC 患者的肝硬化更严重，HCC 分期更晚期。与非 MDRO 定植 HCC 患者相比，MDRO 定植 HCC 患者的生存情况更差，中位 OS 为 189 天（6.3 个月），而非 MDRO 定植 HCC 患者的中位 OS 为 1001 天（33.4 个月）。多因素分析显示，MDRO 定植是影响生存的独立危险因素。
MDRO 定植是 HCC 患者生存的独立危险因素，强调了定期进行 MDRO 筛查、采取隔离措施以及开展多学科抗生素管理项目以指导合理使用抗生素药物的重要性。
