Song Wen, Song Xiaochao, Zhu Yinting, Ren Yalu, Xu Jie, Zhu Qiongfang
Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People's Republic of China.
Department of Infection Management, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People's Republic of China.
Infect Drug Resist. 2023 Aug 17;16:5375-5386. doi: 10.2147/IDR.S420310. eCollection 2023.
Patients after hematopoietic stem cell transplantation (HSCT) are often followed by bloodstream infections (BSIs). BSI is an important cause of non-relapse mortality (NRM) in HSCT patients.
We conducted a retrospective cohort study of patients (aged >14 years) who underwent HSCT at our hospital from 2017 to 2021. Population characteristics, BSI microbiology, resistance to common antibiotics, and 30-day all-cause mortality were analyzed.
Of 3054 patients, 169 (5.5%) had BSIs after HSCT. Male, not in complete remission at transplantation and longer duration of neutropenia were risk factors for the development of BSI after HSCT. These BSIs were Gram-negative bacterial (n=123, 69.49%), Gram-positive bacterial (n=27, 15.25%), fungal (n=11, 6.36%), and polymicrobial (n=16, 9.25%). Among the Gram-negative bacteria, the proportions of isolates resistant to ceftazidime, cefepime, and piperacillin-tazobactam were similar (72.93%, 74.80%, and 77.42%, respectively). The overall drug resistance rates of amikacin and imipenem were 16.13% and 43.90%, respectively. isolates were methicillin-resistant. In isolates, the penicillin resistance rate was 84.62%. Eleven isolates of were resistant to fluconazole and were sensitive to amphotericin B and flucytosine. The 30-day all-cause mortality rate of the 169 patients with BSIs was 8.88%. The 30-day all-cause mortality of patients with Gram-negative bacterial BSIs was 7.32%, 25.00% for polymicrobial BSIs, and 36.36% for fungal BSIs. The 30-day all-cause mortality of patients with fungal BSIs was significantly higher than that of patients with Gram-negative (=0.0023) and Gram-positive bacteria (=0.0023). Fungal BSI and non-Hodgkin's lymphoma (NHL) were associated with higher 30-day mortality.
Our study reveals the microbiological characteristics and 30-day all-cause mortality in patients with bloodstream infections after HSCT. Our data provides strong support for empirical antimicrobial therapy and infection prevention strategies for patients with BSIs after HSCT.
造血干细胞移植（HSCT）后的患者常并发血流感染（BSI）。BSI是HSCT患者非复发死亡率（NRM）的重要原因。
我们对2017年至2021年在我院接受HSCT的患者（年龄>14岁）进行了一项回顾性队列研究。分析了患者的人口统计学特征、BSI微生物学、对常用抗生素的耐药性以及30天全因死亡率。
在3054例患者中，169例（5.5%）在HSCT后发生了BSI。男性、移植时未完全缓解以及中性粒细胞减少持续时间较长是HSCT后发生BSI的危险因素。这些BSI包括革兰氏阴性菌（n = 123，69.49%）、革兰氏阳性菌（n = 27，15.25%）、真菌（n = 11，6.36%）和混合菌（n = 16，9.25%）。在革兰氏阴性菌中，对头孢他啶、头孢吡肟和哌拉西林-他唑巴坦耐药的分离株比例相似（分别为72.93%、74.80%和77.42%）。阿米卡星和亚胺培南的总体耐药率分别为16.13%和43.90%。分离株对甲氧西林耐药。在分离株中，青霉素耐药率为84.62%。11株分离株对氟康唑耐药，对两性霉素B和氟胞嘧啶敏感。169例BSI患者的30天全因死亡率为8.88%。革兰氏阴性菌BSI患者的30天全因死亡率为7.32%，混合菌BSI患者为25.00%，真菌BSI患者为36.36%。真菌BSI患者的30天全因死亡率显著高于革兰氏阴性菌患者（P = 0.0023）和革兰氏阳性菌患者（P = 0.0023）。真菌BSI和非霍奇金淋巴瘤（NHL）与较高的30天死亡率相关。
我们的研究揭示了HSCT后血流感染患者的微生物学特征和30天全因死亡率。我们的数据为HSCT后BSI患者的经验性抗菌治疗和感染预防策略提供了有力支持。
