Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Microb Drug Resist. 2022 May;28(5):593-600. doi: 10.1089/mdr.2021.0253.
We aimed to analyze rates and risk factors for carbapenemase-producing Enterobacterales (CPE) bloodstream infection (BSI) in CPE-colonized patients with malignancies or following hematopoietic cell transplantation. We retrospectively collected data on demography, underlying disease, colonizing CPE, treatment, intensive care unit (ICU) hospitalization, CPE-BSI, and mortality in CPE-colonized immunocompromised patients (2014-2020). Two hundred twenty-one patients were colonized with 272 CPE: 254 (93.4%) carried one carbapenemase [KPC (50.4%), NDM (34.6%), OXA-48-like (5.2%), and VIM (3.3%)]; 18 (6.6%) carried two carbapenemases. Twenty-eight (12.7%) patients developed CPE-BSI. Univariate analysis revealed CPE-BSI-associated factors: younger age, carbapenem or aminoglycoside exposure, ICU admission, neutropenia, carrying serine carbapenemase-producing, and specifically KPC-producing bacteria, colonization with several CPE, and detection of several carbapenemases. None of 23 auto-HSCT recipients developed CPE-BSI. In multivariate analysis, ICU hospitalization was significantly associated with CPE-BSI (odds ratio [OR] 2.82, 95% CI 1.10-7.20; = 0.042); solid tumor diagnosis was protective (OR 0.21, 95% CI 0.05-1.01; = 0.038). One-year crude mortality was 108/221 (48.8%), including 19/28 (67.9%) and 89/193 (46.1%) in patients with and without CPE-BSI, = 0.104. To conclude, CPE-BSI is rare in CPE-colonized patients with solid tumors and following auto-HSCT. ICU hospitalization increased CPE-BSI risk. These data can help to guide empirical anti-CPE antibiotic therapy in patients colonized with these bacteria.
我们旨在分析在患有恶性肿瘤或接受造血细胞移植后发生碳青霉烯酶产生肠杆菌科（CPE）血流感染（BSI）的 CPE 定植患者中，CPE 血流感染（BSI）的发生率和危险因素。我们回顾性地收集了 2014 年至 2020 年间，在免疫功能低下的 CPE 定植患者（CPE 定植患者）中，人口统计学、基础疾病、定植 CPE、治疗、重症监护病房（ICU）住院、CPE-BSI 和死亡率的数据。221 例患者定植 272 株 CPE：254 株（93.4%）携带一种碳青霉烯酶[KPC（50.4%）、NDM（34.6%）、OXA-48 样（5.2%）和 VIM（3.3%）]；18 株（6.6%）携带两种碳青霉烯酶。28 例（12.7%）患者发生 CPE-BSI。单因素分析显示与 CPE-BSI 相关的因素：年龄较小、碳青霉烯类或氨基糖苷类药物暴露、入住 ICU、中性粒细胞减少症、携带丝氨酸碳青霉烯酶产生菌，特别是 KPC 产生菌、定植多种 CPE 以及检测到多种碳青霉烯酶。23 例自动 HSCT 受者无一例发生 CPE-BSI。多因素分析显示，入住 ICU 与 CPE-BSI 显著相关（比值比 [OR] 2.82，95%CI 1.10-7.20；=0.042）；实体瘤诊断具有保护作用（OR 0.21，95%CI 0.05-1.01；=0.038）。221 例患者中有 108 例（48.8%）死亡，包括 28 例 CPE-BSI 患者中的 19 例（67.9%）和 193 例无 CPE-BSI 患者中的 89 例（46.1%），=0.104。总之，在实体瘤患者和自动 HSCT 后发生 CPE 定植的患者中，CPE-BSI 很少见。入住 ICU 增加了 CPE-BSI 的风险。这些数据有助于指导定植此类细菌的患者经验性抗 CPE 抗生素治疗。
