对携带KPC-的急性白血病发热性中性粒细胞减少患者进行针对KPC-的经验性抗生素治疗的获益与安全性。一项7年回顾性观察队列研究。
Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC- in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-. A 7-Years Retrospective Observational Cohort Study.
作者信息
Micozzi Alessandra, Minotti Clara, Capria Saveria, Cartoni Claudio, Trisolini Silvia Maria, Assanto Giovanni Manfredi, Barberi Walter, Moleti Maria Luisa, Santilli Stefania, Martelli Maurizio, Gentile Giuseppe
机构信息
Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy.
出版信息
Infect Drug Resist. 2023 Jan 31;16:695-704. doi: 10.2147/IDR.S393802. eCollection 2023.
PURPOSE
To evaluate the benefits and safety of the empiric antibiotic treatment (EAT) active against KPC- in febrile neutropenic patients with acute leukaemia (AL) who are colonised by KPC-
PATIENTS AND METHODS
A 7-year (2013-2019) retrospective observational cohort study was conducted at the Haematology, Sapienza Rome University (Italy) on 94 febrile neutropenia episodes (FNE) in AL patients KPC- carriers treated with active EAT.
RESULTS
Eighty-two (87%) FNE were empirically treated with antibiotic combinations [38 colistin-based and 44 ceftazidime-avibactam (CAZAVI)-based], 12 with CAZAVI monotherapy. Successful outcomes were observed in 88/94 (94%) FNE, 46/49 (94%) microbiologically documented infections, and 24/27 (89%) gram-negative bloodstream infections (GNB-BSI). Mortality due to infective causes was 4.2% (2.1% within 1 week). KPC infections caused 28/94 FNE (30%) and KPCBSI was documented in 22 FNE (23.4%) (85% of GNB-BSI), in all cases patients received active EAT, and 21 survived. KPCBSI mortality rate was 4.5%. CAZAVI-based EAT showed better results than colistin-based EAT (55/56 vs 33/38, p = 0.037), overall and without EAT modification (41/56 vs 20/38, p = 0.02). Empirical combinations including CAZAVI were successful in 98% of cases (43/44 vs 33/38 for colistin-based EAT, p = 0.01), without modifications in 82% (36/44 vs 20/28, p = 0.02). All deaths occurred in patients treated with colistin-based EAT (4/38 vs 0/56, p = 0.02). CAZAVI-containing EAT was the only independent factor for an overall successful response (HR 0.058, CI 0.013-1.072, p = 0.058). Nephrotoxicity occurred in 3(8%) patients undergoing colistin-based EAT (none in those undergoing CAZAVI-based EAT, p = 0.02).
CONCLUSION
KPC- infections are frequent in colonised AL patients with FNE. EAT with active antibiotics, mainly CAZAVI-based combinations, was effective, safe, and associated with low overall and KPCBSI-related mortality.
目的
评估对产KPC酶菌有活性的经验性抗生素治疗（EAT）在急性白血病（AL）伴发热性中性粒细胞减少且产KPC酶菌定植患者中的益处和安全性。
患者与方法
在意大利罗马第二大学血液科进行了一项为期7年（2013 - 2019年）的回顾性观察队列研究，纳入94例接受活性EAT治疗的AL产KPC酶菌携带者发热性中性粒细胞减少发作（FNE）。
结果
82例（87%）FNE接受了抗生素联合治疗[38例基于黏菌素，44例基于头孢他啶 - 阿维巴坦（CAZAVI）]，12例接受CAZAVI单药治疗。88/94例（94%）FNE、46/49例（94%）微生物学确诊感染以及24/27例（89%）革兰阴性菌血流感染（GNB - BSI）获得成功结局。感染性病因导致的死亡率为4.2%（1周内为2.1%）。产KPC酶菌感染导致28/94例FNE（30%），22例FNE（23.4%）记录有产KPC酶菌血流感染（KPCBSI）（占GNB - BSI的85%），所有病例患者均接受活性EAT，21例存活。KPCBSI死亡率为4.5%。基于CAZAVI的EAT比基于黏菌素的EAT效果更好（55/56对比33/38，p = 0.037），总体情况以及未调整EAT时均如此（41/56对比20/38，p = 0.02）。包含CAZAVI的经验性联合治疗在98%的病例中成功（基于黏菌素的EAT为43/44对比33/38，p = 0.01），未调整时为82%（36/44对比20/28，p = 0.02）。所有死亡均发生在接受基于黏菌素的EAT治疗的患者中（4/38对比0/56，p = 0.02）。含CAZAVI的EAT是总体成功反应的唯一独立因素（风险比0.058，可信区间0.013 - 1.072，p = 0.058）。3例（8%）接受基于黏菌素的EAT治疗的患者发生肾毒性（接受基于CAZAVI的EAT治疗的患者中无肾毒性发生，p = 0.02）。
结论
在AL伴FNE且产KPC酶菌定植的患者中，产KPC酶菌感染很常见。使用活性抗生素进行EAT，主要是基于CAZAVI的联合治疗，有效、安全，且总体及与KPCBSI相关的死亡率较低。
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