Herrera Sabina, Morata Laura, Sempere Abiu, Verdejo Miguel, Del Rio Ana, Martínez Jose Antonio, Cuervo Guillermo, Hernández-Meneses Marta, Chumbita Mariana, Pitart Cristina, Puerta Pedro, Monzó Patricia, Lopera Carles, Aiello Francesco, Mendoza Scarleth, Garcia-Vidal Carolina, Soriano Alex, Bodro Marta
Department of Infectious Diseases, Hospital Clínic, 08036 Barcelona, Spain.
Department of Microbiology, Hospital Clínic, 08036 Barcelona, Spain.
Antibiotics (Basel). 2023 Feb 13;12(2):380. doi: 10.3390/antibiotics12020380.
The prevalence of antimicrobial resistance of () in solid organ transplant (SOT) recipients is higher than that of the general population. However, the literature supporting this statement is scarce. Identifying patients at risk of carbapenem resistance (CR) is of great importance, as CR strains more often receive inappropriate empiric antibiotic therapy, which is independently associated with mortality in bloodstream infections (BSIs).
We prospectively recorded data from all consecutive BSIs from January 1991 to July 2019 using a routine purpose-designed surveillance database. The following variables were included: age, sex, type of transplant, use of vascular and urinary catheters, presence of neutropenia, period of diagnosis, treatment with steroids, origin of BSI, source of bacteremia, septic shock, ICU admission, mechanical ventilation, previous antibiotic treatment, treatment of bacteremia, and 30-day all-cause mortality.
We identified 2057 episodes of BSI. Of these, 265 (13%) episodes corresponded to SOT recipients (130 kidney transplants, 105 liver, 9 hearts, and 21 kidney-pancreas). Hematologic malignancy [OR 2.71 (95% CI 1.33-5.51), = 0.006] and prior carbapenem therapy [OR 2.37 (95% CI 1.46-3.86), < 0.001] were associated with a higher risk of having a CR BSI. Age [OR 1.03 (95% CI 1.02-1.04) < 0.001], urinary catheter [OR 2.05 (95% CI 0.37-3.06), < 0.001], shock at onset [OR 6.57 (95% CI 4.54-9.51) < 0.001], high-risk source [OR 4.96 (95% CI 3.32-7.43) < 0.001], and bacteremia caused by CR strains [OR 1.53 (95% CI 1.01-2.29) = 0.036] were associated with increased mortality. Correct empirical therapy was protective [OR 0.52 (95% CI 0.35-0.75) = 0.001]. Mortality at 30 days was higher in non-SOT patients (21% vs. 13%, = 0.002). SOT was not associated with a higher risk of having a CR BSI or higher mortality.
In our cohort of 2057 patients with BSIs, hematologic malignancies and previous carbapenem therapy were independently associated with a risk of presenting CR BSI. Age, urinary catheter, high-risk source, bacteremia caused by carbapenem-resistant strains, and severity of the infection were independently associated with mortality, whereas correct empirical therapy was a protective factor. An increasing trend in the resistance of was found, with >30% of the isolates being resistant to carbapenems in the last period. SOT was not associated with a higher risk of carbapenem-resistant BSIs or higher mortality.
实体器官移植（SOT）受者中（）的抗菌药物耐药率高于普通人群。然而，支持这一说法的文献很少。识别有碳青霉烯耐药（CR）风险的患者非常重要，因为CR菌株更常接受不恰当的经验性抗生素治疗，这与血流感染（BSI）的死亡率独立相关。
我们使用专门设计的常规监测数据库，前瞻性记录了1991年1月至2019年7月期间所有连续性BSI的数据。纳入以下变量：年龄、性别、移植类型、血管和尿管的使用情况、中性粒细胞减少症的存在、诊断时间、类固醇治疗、BSI的来源、菌血症的来源、感染性休克、入住重症监护病房、机械通气、既往抗生素治疗、菌血症治疗以及30天全因死亡率。
我们识别出2057例BSI发作。其中，265例（13%）发作对应SOT受者（130例肾移植、105例肝移植、9例心脏移植和21例肾胰联合移植）。血液系统恶性肿瘤[比值比（OR）2.71（95%置信区间1.33 - 5.51），P = 0.006]和既往碳青霉烯治疗[OR 2.37（95%置信区间1.46 - 3.86），P < 0.001]与CR BSI风险较高相关。年龄[OR 1.03（95%置信区间1.02 - 1.04），P < 0.001]、尿管[OR 2.05（95%置信区间0.37 - 3.06），P < 0.001]、发病时休克[OR 6.57（95%置信区间4.54 - 9.51），P < 0.001]、高风险来源[OR 4.96（95%置信区间3.32 - 7.43），P < 0.001]以及由CR菌株引起的菌血症[OR 1.53（95%置信区间1.01 - 2.29），P = 0.036]与死亡率增加相关。正确的经验性治疗具有保护作用[OR 0.52（95%置信区间0.35 - 0.75），P = 0.001]。非SOT患者的30天死亡率更高（21%对13%，P = 0.002）。SOT与CR BSI风险较高或死亡率较高无关。
在我们的2057例BSI患者队列中，血液系统恶性肿瘤和既往碳青霉烯治疗与出现CR BSI的风险独立相关。年龄、尿管、高风险来源、碳青霉烯耐药菌株引起的菌血症以及感染的严重程度与死亡率独立相关，而正确的经验性治疗是一个保护因素。发现（）的耐药性呈上升趋势，在最后阶段超过三分之一分离株对碳青霉烯类耐药。SOT与碳青霉烯耐药性BSI风险较高或死亡率较高无关。
