Choi Hyeah, Ahn Hyojin, Lee Raeseok, Cho Sung-Yeon, Lee Dong-Gun
Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
The Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Korea.
Infect Chemother. 2022 Jun;54(2):340-352. doi: 10.3947/ic.2022.0069.
Patients with hematologic diseases are at high risk of bloodstream infections (BSIs). This study aimed to analyze clinical features and distributions of microorganisms in patients with hematologic diseases presenting at a tertiary care university-affiliated hospital in Korea.
We retrospectively reviewed all BSI episodes recorded in patient medical records at two hematologic wards of the Catholic Hematology Hospital from January to December 2020. Our aim was to analyze demographic and clinical characteristics relevant to BSIs. We also described the antimicrobial resistance patterns of the major pathogens identified in this study, and evaluated risk factors for extended-spectrum beta-lactamase (ESBL) production in isolates and for vancomycin resistance in enterococcal isolates.
A total of 380 BSI episodes were identified in 334 patients over the course of 1 year (monomicrobial BSI episodes, 86.1%; polymicrobial BSI episodes, 13.9%). Gram-negative bacteria accounted for 242 isolates (54.8%). The most frequently isolated Gram-negative bacteria isolates were (107 [24.2%]) followed by spp. (72 [16.3%]), spp. (21 [4.8%]), and spp. (12 [2.7%]). The most commonly identified Gram-positive bacteria were spp. (72 [16.3%]) followed by viridans streptococci (54 [12.2%]), coagulase-negative staphylococci (CoNS) (24 [5.4%]), and spp. (22 [5.0%]). ESBL-producing accounted for 25.1% of the total distribution. Among 54 isolates, 100.0% were resistant to ampicillin and 55.6% showed resistance to vancomycin, while 100.0% (n = 12) of isolates were susceptible to ampicillin and vancomycin, respectively. Use of ciprofloxacin prophylaxis (odds ratio: 5.20; 95% confidence interval: 1.11 - 24.34; = 0.04) was an independent risk factor for ESBL production in BSIs.
Compared with the results of a previous study conducted at the same institution, our findings demonstrated that Gram-negative bacteria remained dominant pathogens in BSIs occurring in patients with hematologic diseases. Our findings also demonstrated a comparatively decreased prevalence of ESBL-producing in the evaluated BSIs. However, the prevalence of enterococcal BSIs had not decreased, and the proportion of vancomycin-resistant isolates from BSIs had increased. In addition, we found that ciprofloxacin prophylaxis was statistically significantly associated with ESBL production in BSIs. We conclude that, in order to avoid critical complications and to reduce the burden of antimicrobial-resistant organisms in patients with hematologic diseases, it is necessary to conduct periodic examinations evaluating changes in BSI epidemiology within a single medical center.
血液系统疾病患者发生血流感染（BSIs）的风险很高。本研究旨在分析韩国一家大学附属医院三级医疗中心血液系统疾病患者的临床特征及微生物分布情况。
我们回顾性分析了2020年1月至12月天主教血液病医院两个血液科病房患者病历中记录的所有BSI发作情况。我们的目的是分析与BSIs相关的人口统计学和临床特征。我们还描述了本研究中鉴定出的主要病原体的抗菌药物耐药模式，并评估了分离株中产超广谱β-内酰胺酶（ESBL）及肠球菌分离株中耐万古霉素的危险因素。
在1年的时间里，共在334例患者中鉴定出380次BSI发作（单一微生物BSI发作，86.1%；多微生物BSI发作，13.9%）。革兰氏阴性菌占242株（54.8%）。最常分离出的革兰氏阴性菌是大肠埃希菌（107株[24.2%]），其次是肺炎克雷伯菌属（72株[16.3%]）、铜绿假单胞菌（21株[4.8%]）和鲍曼不动杆菌（12株[2.7%]）。最常鉴定出的革兰氏阳性菌是金黄色葡萄球菌（72株[16.3%]），其次是草绿色链球菌（54株[12.2%]）、凝固酶阴性葡萄球菌（CoNS）（24株[5.4%]）和肠球菌属（22株[5.0%]）。产ESBL的大肠埃希菌占总分布的25.1%。在54株肠球菌分离株中，100.0%对氨苄西林耐药，55.6%对万古霉素耐药，而100.0%（n = 12）的屎肠球菌分离株分别对氨苄西林和万古霉素敏感。预防性使用环丙沙星（比值比：5.20；95%置信区间：1.11 - 24.34；P = 0.04）是大肠埃希菌BSIs中产ESBL的独立危险因素。
与之前在同一机构进行的研究结果相比，我们的研究结果表明革兰氏阴性菌仍然是血液系统疾病患者BSIs中的主要病原体。我们的研究结果还表明，在评估的BSIs中，产ESBL大肠埃希菌的患病率相对下降。然而，肠球菌BSIs的患病率并未下降，并且屎肠球菌BSIs中耐万古霉素分离株的比例有所增加。此外，我们发现预防性使用环丙沙星与大肠埃希菌BSIs中产ESBL在统计学上有显著关联。我们得出结论，为避免严重并发症并减轻血液系统疾病患者中抗菌药物耐药菌的负担，有必要在单一医疗中心定期进行检查，评估BSI流行病学的变化。
