Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.
Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China.
Front Cell Infect Microbiol. 2023 Jan 13;12:1098856. doi: 10.3389/fcimb.2022.1098856. eCollection 2022.
Carbapenem resistant gram-negative bacteria (CRGNB) infection is more and more frequent in patients after hematopoietic stem cell transplantation (HSCT), and the prognosis is very poor. The purpose of this study was to investigate the clinical characteristics and risk factors for mortality with CRGNB infection in HSCT recipients, and to provide useful information for guiding the application of antibiotics and improving the prognosis in the future.
Electronic medical records of CRGNB infected patients who underwent HSCT in Xiangya Hospital from January 1, 2015 to June 30, 2022 were collected. At the same time, 1:1 case-control matching was performed according to gender, age and disease type. The epidemiological characteristics and drug resistance of patients with CRGNB infection and non-CRGNB infection were compared. Logistic regression and Cox regression analysis were used to determine the risk factors for CRGNB acquisition and death respectively, and a prediction model of overall survival was constructed by R language.
The crude infection rate of CRGNB in HSCT recipients was 7.42%, and the mortality rate was 47.1%. CRGNB was resistant to most commonly used antibiotics. Time interval from diagnosis to transplantation >180 days (HR=7.886, 95% CI 2.624-23.703, =0.000), septic shock (HR=6.182, 95% CI 2.605-14.671, =0.000), platelet count < 20 × 10/L (HR=2.615, 95% CI 1.152-5.934, =0.022) and total bilirubin > 34.2 μmol/L (HR=7.348, 95% CI 2.966-18.202, =0.000) at the initial stage of infection were 4 independent risk factors associated with mortality. CRGNB infection has become a serious threat to HSCT recipients. Clinicians should pay high attention to it and actively seek personalized treatment strategies suitable for local medical conditions.
碳青霉烯类耐药革兰氏阴性菌（CRGNB）感染在造血干细胞移植（HSCT）后患者中越来越频繁，预后非常差。本研究旨在探讨 HSCT 受者 CRGNB 感染的临床特征和死亡的危险因素，为今后指导抗生素的应用和改善预后提供有用信息。
收集 2015 年 1 月 1 日至 2022 年 6 月 30 日在湘雅医院接受 HSCT 并发生 CRGNB 感染的患者的电子病历。同时，根据性别、年龄和疾病类型进行 1:1 病例对照匹配。比较 CRGNB 感染和非 CRGNB 感染患者的流行病学特征和耐药性。采用 logistic 回归和 Cox 回归分析分别确定获得 CRGNB 和死亡的危险因素，并通过 R 语言构建总体生存预测模型。
HSCT 受者 CRGNB 的粗感染率为 7.42%，死亡率为 47.1%。CRGNB 对大多数常用抗生素均耐药。从诊断到移植的时间间隔>180 天（HR=7.886，95%CI 2.624-23.703，=0.000）、感染性休克（HR=6.182，95%CI 2.605-14.671，=0.000）、血小板计数<20×10/L（HR=2.615，95%CI 1.152-5.934，=0.022）和初始感染时总胆红素>34.2μmol/L（HR=7.348，95%CI 2.966-18.202，=0.000）是与死亡相关的 4 个独立危险因素。CRGNB 感染已成为 HSCT 受者的严重威胁。临床医生应高度重视，并积极寻求适合当地医疗条件的个性化治疗策略。
