中国碳青霉烯类耐药血流感染住院患者的危险因素及转归：一项9年趋势及多中心队列研究
Risk factors and outcomes of inpatients with carbapenem-resistant bloodstream infections in China: a 9-year trend and multicenter cohort study.
作者信息
Yuan Qing, Guo Lei, Li Bin, Zhang Sheng, Feng Haiting, Zhang Yan, Yu Meihong, Hu Hangbin, Chen Hongchao, Yang Qing, Qu Tingting
机构信息
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China.
Department of Infection Control, Wenzhou Medical University of the Second Affiliated Hospital, Wenzhou, Zhejiang, China.
出版信息
Front Microbiol. 2023 May 18;14:1137811. doi: 10.3389/fmicb.2023.1137811. eCollection 2023.
OBJECTIVE
Bacteremia caused by carbapenem-resistant (CRPA) has high mortality, threatening the healthcare quality worldwide. Analysis is required to update the epidemiological data of CRPA bloodstream infections (BSI) and evaluate the prevalent strains in China. Moreover, it is necessary to clarify the risk factors associated with the development and mortality of CRPA bacteremia.
METHODS
This is a 9-year multicenter retrospective study, enrolling 137 patients with CRPA BSI and 137 carbapenem-susceptible (CSPA) BSI during January 2012 and December 2020. Antimicrobials susceptibility between the two groups were compared. Risk factors of CRPA BSI were identified by binary logistic regression for development and cox regression for mortality. The Kaplan-Meier method was used to compare time to mortality. CRPA and difficult-to-treat resistant (DTRPA) detection rate was analyzed year-by-year in ZYH.
RESULTS
A total of 7,384 clinical samples were cultured in ZYH during 9 years, and notable increase of CRPA and DTRPA detection rate in BSI was identified (from 17 to 60%; from 2.1 to 25%). Multivariate analysis revealed that prior ICU hospitalization, immunosuppressive therapy and exposure to carbapenems were independent risk factors for development of CRPA BSI. The 30-day crude mortality of 137 CRPA BSI was 39%. A total of 46 DTRPA were identified, and the 30-day mortality for patients infected by DTRPA was 50%. The 30-day crude mortality of CRPA BSI was independently associated with multiple organ failure and higher Pitt bacteremia score, whereas receipt appropriate therapy improved prognosis.
CONCLUSION
A significant increase in the detection rate of CRPA and DTRPA in BSI was identified. Strict policies for carbapenems usage, cautious decisions regarding the usage of immunosuppressive agent and standard care for patients with prior ICU hospitalization are necessary for CRPA BSI management.
目的
耐碳青霉烯类肠杆菌科细菌（CRPA）引起的菌血症死亡率高，威胁全球医疗质量。需要进行分析以更新CRPA血流感染（BSI）的流行病学数据，并评估中国的流行菌株。此外，有必要阐明与CRPA菌血症发生和死亡率相关的危险因素。
方法
这是一项为期9年的多中心回顾性研究，纳入了2012年1月至2020年12月期间137例CRPA BSI患者和137例碳青霉烯类敏感（CSPA）BSI患者。比较两组之间的抗菌药物敏感性。通过二元逻辑回归分析CRPA BSI发生的危险因素，通过Cox回归分析死亡率的危险因素。采用Kaplan-Meier方法比较死亡时间。逐年分析ZYH中CRPA和难治疗耐药菌（DTRPA）的检出率。
结果
9年间ZYH共培养7384份临床样本，发现BSI中CRPA和DTRPA检出率显著增加（从17%增至60%；从2.1%增至25%）。多变量分析显示，既往入住重症监护病房（ICU）、免疫抑制治疗和接触碳青霉烯类药物是CRPA BSI发生的独立危险因素。137例CRPA BSI患者的30天粗死亡率为39%。共鉴定出46株DTRPA，感染DTRPA患者的30天死亡率为50%。CRPA BSI的30天粗死亡率与多器官功能衰竭和较高的皮特菌血症评分独立相关，而接受适当治疗可改善预后。
结论
发现BSI中CRPA和DTRPA的检出率显著增加。对于CRPA BSI的管理，需要制定严格的碳青霉烯类药物使用政策，谨慎决定免疫抑制剂的使用，并对既往入住ICU的患者进行规范治疗。
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