Lu Linli, Xu Cong, Tang Yishu, Wang Liwen, Cheng Qian, Chen Xin, Zhang Jian, Li Ying, Xiao Han, Li Xin
Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Infect Drug Resist. 2022 Jun 4;15:2901-2914. doi: 10.2147/IDR.S359833. eCollection 2022.
Carbapenem-resistant Gram-negative bacteria (CRGNB) bloodstream infection (BSI) pose a significant threat to the prognosis of hematologic malignancies (HM) patients. Understanding the distribution of pathogenic bacteria, changes in carbapenem-resistant trends, risk factors for CRGNB infections, and exploring the early detection measures can help reduce mortality.
We conducted a multicenter retrospective study of Gram-negative bacteria (GNB) BSI in patients with HM in three university-affiliated hospitals in Hunan Province, China, from January 2010 to December 2020. Demographic and clinical data were collected from the hospital electronic medical records system.
CRGNB caused 138 (15.3%) of 902 GNB BSI. The detection rate of CRGNB increased from 6.4% in 2010-2012 to 35.4% in 2019-2020. The 7-day mortality rate was significantly higher in patients with CRGNB BSI than in patients with carbapenem-susceptible Gram-negative bacteria (CSGNB) BSI [31.9% (44/138) vs 9.7% (74/764), P < 0.001], and the mortality rate in patients with carbapenem-resistant non-fermenting bacteria (CRNFB) bloodstream infections was generally higher than that of carbapenem-resistant Enterobacteriaceae (CRE). Urinary catheter (OR, 2.814; CI=1.395-5.680; P=0.004) and prior exposure to carbapenem (OR, 4.372; CI=2.881-6.635; P<0.001) were independent risk factors for CRGNB BSI. Analysis of co-infections showed that 50%-85% of patients with CRGNB BSI had pulmonary infections, sputum culture results suggested that sputum culture positivity rate was as high as 57.1%-66.7% in patients with carbapenem-resistant (CRAB) and BSI, and the results of antimicrobial susceptibility testing of sputum cultures were consistent with the blood cultures.
Carbapenem resistance has dramatically increased in HM patients with GNB BSI in recent years and is associated with a worse outcome, especially for non-fermenting bacteria. In high-risk patients, early screening of the respiratory tract specimens may help to detect CRNFB colonization and protect patients from breakthrough BSI.
耐碳青霉烯类革兰阴性菌（CRGNB）血流感染（BSI）对血液系统恶性肿瘤（HM）患者的预后构成重大威胁。了解病原菌的分布、耐碳青霉烯类趋势的变化、CRGNB感染的危险因素，并探索早期检测措施有助于降低死亡率。
我们对2010年1月至2020年12月在中国湖南省三家大学附属医院的HM患者中革兰阴性菌（GNB）BSI进行了一项多中心回顾性研究。从医院电子病历系统收集人口统计学和临床数据。
902例GNB BSI中，CRGNB导致138例（15.3%）。CRGNB的检出率从2010 - 2012年的6.4%升至2019 - 2020年的35.4%。CRGNB BSI患者的7天死亡率显著高于碳青霉烯类敏感革兰阴性菌（CSGNB）BSI患者[31.9%（44/138）对9.7%（74/764），P < 0.001]，耐碳青霉烯类非发酵菌（CRNFB）血流感染患者的死亡率普遍高于耐碳青霉烯类肠杆菌科细菌（CRE）。导尿管（OR，2.814；CI = 1.395 - 5.680；P = 0.004）和既往接触碳青霉烯类（OR，4.372；CI = 2.881 - 6.635；P < 0.001）是CRGNB BSI的独立危险因素。合并感染分析显示，50% - 85%的CRGNB BSI患者有肺部感染，痰培养结果提示耐碳青霉烯类鲍曼不动杆菌（CRAB）BSI患者的痰培养阳性率高达57.1% - 66.7%，痰培养的药敏试验结果与血培养一致。
近年来，HM患者GNB BSI中碳青霉烯类耐药性显著增加，且与更差的预后相关，尤其是对于非发酵菌。在高危患者中，早期筛查呼吸道标本可能有助于检测CRNFB定植并保护患者免受突破性BSI感染。
