Tang Yishu, Xu Cong, Xiao Han, Wang Liwen, Cheng Qian, Li Xin
Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Infect Drug Resist. 2021 Aug 12;14:3115-3124. doi: 10.2147/IDR.S322812. eCollection 2021.
(EB) and non-fermentative bacteria (NFB) are the main pathogens responsible for gram-negative bloodstream infections (GN-BSI) in patients with hematological malignancies (HMs). These two pathogen types have heterogeneous resistance mechanisms to antibiotics. However, the impact of pathogen species and pattern of antibiotic resistance on the outcomes of patients with HMs remains unclear.
We retrospectively collected clinical data of patients with HMs at three comprehensive hospitals in Hunan Province, China, between January 2010 and May 2018. The data analyzed the impact that different species and patterns of antibiotic resistance had on the outcome of patients with HMs.
The majority of the 835 monomicrobial isolates collected from patients with HMs and GN-BSIs were (75.7%). While detections of MDR pathogens in BSIs as a whole are decreasing, sub-analysis shows that detections of extended spectrum β-lactamase-producing (ESBL) and carbapenem-resistant pathogens in BISs are rising. Comparing different species, the early mortality rate associated with infections caused by NFB was significantly higher than infections caused by (22.6% vs 9.7%, p < 0.001). Across different multidrug-resistant (MDR) patterns, ESBL bacteria did not have a significant impact on health outcomes. Carbapenem-resistant bacteria, on the other hand, were observed to significantly affect early mortality rate, such as carbapenem-resistant (36.0% vs 7.6%, P < 0.001) and carbapenem-resistant non-fermentative bacteria (44.7% vs 16.5%, P < 0.001).
Our findings suggest that both species and patterns of antibiotic resistance can affect the early mortality of patients with HMs during BSI.
肠杆菌科细菌（EB）和非发酵菌（NFB）是血液系统恶性肿瘤（HMs）患者革兰阴性血流感染（GN-BSI）的主要病原体。这两种病原体对抗生素具有不同的耐药机制。然而，病原体种类和抗生素耐药模式对HMs患者预后的影响仍不清楚。
我们回顾性收集了2010年1月至2018年5月期间中国湖南省三家综合医院HMs患者的临床资料。该数据分析了不同种类和抗生素耐药模式对HMs患者预后的影响。
从HMs和GN-BSIs患者中收集的835株单一微生物分离株中，大多数是肠杆菌科细菌（75.7%）。虽然总体上血流感染中多重耐药病原体的检测率在下降，但亚分析显示，血流感染中产生超广谱β-内酰胺酶（ESBL）的病原体和耐碳青霉烯类病原体的检测率在上升。比较不同种类，NFB引起的感染相关早期死亡率显著高于肠杆菌科细菌引起的感染（22.6%对9.7%，p<0.001）。在不同的多重耐药（MDR）模式中，ESBL细菌对健康结局没有显著影响。另一方面，观察到耐碳青霉烯类细菌显著影响早期死亡率，如耐碳青霉烯类肠杆菌科细菌（36.0%对7.6%，P<0.001）和耐碳青霉烯类非发酵菌（44.7%对16.5%，P<0.001）。
我们的研究结果表明，病原体种类和抗生素耐药模式均可影响HMs患者血流感染期间的早期死亡率。
