Wu Qiuling, Qian Chenjing, Yin Hua, Liu Fang, Wu Yaohui, Li Weiming, Xia Linghui, Ma Ling, Hong Mei
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 May 11;12:897479. doi: 10.3389/fonc.2022.897479. eCollection 2022.
This study investigated the high-risk factors associated with the increased vulnerability for subsequent clinical CR-GNB infection in carbapenem-resistant Gram-negative bacteria (CR-GNB)-colonized hematological malignancy (HM) patients and built a statistical model to predict subsequent infection.
All adult HM patients with positive rectoanal swabs culture for CR-GNB between January 2018 and June 2020 were prospectively followed to assess for any subsequent CR-GNB infections and to investigate the risk factors and clinical features of subsequent infection.
A total of 392 HM patients were enrolled. Of them, 46.7% developed a subsequent clinical CR-GNB infection, with 42 (10.7%) cases of confirmed infection and 141 (36%) cases of clinically diagnosed infection. was the dominant species. The overall mortality rate of patients colonized and infected with CR-GNB was 8.6% and 43.7%. A multivariate analysis showed that remission induction chemotherapy and the duration of agranulocytosis, mucositis, and hypoalbuminemia were significant predictors of subsequent infection after CR-GNB colonization. According to our novel risk-predictive scoring model, the high-risk group were >3 times more likely to develop a subsequent infection in comparison with the low-risk group.
Our risk-predictive scoring model can early and accurately predict a subsequent CR-GNB infection in HM patients with CR-GNB colonization. The early administration of CR-GNB-targeted empirical therapy in the high-risk group is strongly recommended to decrease their mortality.
本研究调查了耐碳青霉烯类革兰阴性菌（CR-GNB）定植的血液系统恶性肿瘤（HM）患者后续发生临床CR-GNB感染易感性增加的相关高危因素，并建立了一个统计模型来预测后续感染。
对2018年1月至2020年6月间直肠肛门拭子CR-GNB培养阳性的所有成年HM患者进行前瞻性随访，以评估是否发生任何后续CR-GNB感染，并调查后续感染的危险因素和临床特征。
共纳入392例HM患者。其中，46.7%发生了后续临床CR-GNB感染，确诊感染42例（10.7%），临床诊断感染141例（36%）。 是主要菌种。CR-GNB定植和感染患者的总死亡率分别为8.6%和43.7%。多因素分析显示，缓解诱导化疗以及粒细胞缺乏症、粘膜炎和低白蛋白血症的持续时间是CR-GNB定植后后续感染的重要预测因素。根据我们新的风险预测评分模型，高危组发生后续感染的可能性是低危组的3倍以上。
我们的风险预测评分模型可以早期、准确地预测CR-GNB定植的HM患者后续的CR-GNB感染。强烈建议对高危组尽早给予针对CR-GNB的经验性治疗，以降低其死亡率。
