University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia.
Queensland University of Technology (QUT), Brisbane, QLD, Australia.
Clin Exp Med. 2023 Dec;23(8):4563-4573. doi: 10.1007/s10238-023-01206-x. Epub 2023 Oct 10.
Knowledge of the epidemiology of bloodstream infection (BSI) in haematology patients is essential to guide patient management. We investigated the epidemiology of BSI in patients with haematological malignancies in Queensland over the last 20 years (2000-2019), including all episodes diagnosed by the state-wide microbiology service. We identified 7749 BSI in 5159 patients, 58% associated with neutropenia. Gram-negatives were the main causative pathogens (58.3%), more frequent in neutropenic than non-neutropenic patients (3308/5309, 62.3% vs 1932/3678, 52.5%, p < 0.001). Amongst 8987 isolates the most common were E. coli (15.4%) and Pseudomonas spp. (14.2%). Pseudomonas spp. (16.6% vs 10.7%, p < 0.001), Klebsiella spp. (11.6% vs 6.8%, p < 0.001), viridans-group streptococci (4.4% vs 1.2%, p < 0.001) and E. faecium (2.4% vs 0.9%, p < 0.001) were more common in neutropenic than non-neutropenic patients, while S. aureus was less common (5.9% vs 15.6%, p < 0.001). Several antimicrobial resistance rates increased over time and had higher prevalence in neutropenic than non-neutropenic patients, including ciprofloxacin-resistant E. coli (94/758, 12.4% vs 42/506, 8.3%, p = 0.021), trimethoprim-sulfamethoxazole-resistant E. coli (366/764, 47.9% vs 191/517, 36.9%, p < 0.001), penicillin-resistant streptococci (51/236, 21.6% vs 28/260, 10.8%, p < 0.001) and vancomycin-resistant enterococci (46/250, 18.4% vs 9/144, 6.3%, p < 0.001). Carbapenem-resistant Pseudomonas spp. (OR 7.32, 95%CI 2.78-19.32) and fungi, including yeasts and moulds (OR 3.33, 95%CI 2.02-5.48) were associated to the highest odds of 30-day case-fatality at a multivariable logistic regression analysis. Neutropenia was associated with survival (OR 0.66, 95%CI 0.55-0.78). Differences were observed in the BSI epidemiology according to neutropenic status, with an overall increase of resistance over time associated to adverse outcome.
血液病患者血流感染（BSI）的流行病学知识对于指导患者管理至关重要。我们调查了过去 20 年（2000-2019 年）昆士兰州血液病患者的 BSI 流行病学情况，包括全州微生物学服务诊断的所有病例。我们在 5159 名患者中发现了 7749 例 BSI，其中 58%与中性粒细胞减少症有关。革兰氏阴性菌是主要的病原体（58.3%），在中性粒细胞减少症患者中比非中性粒细胞减少症患者更常见（3308/5309，62.3%比 1932/3678，52.5%，p < 0.001）。在 8987 株分离株中，最常见的是大肠杆菌（15.4%）和假单胞菌属（14.2%）。假单胞菌属（16.6%比 10.7%，p < 0.001）、克雷伯菌属（11.6%比 6.8%，p < 0.001）、草绿色链球菌（4.4%比 1.2%，p < 0.001）和屎肠球菌（2.4%比 0.9%，p < 0.001）在中性粒细胞减少症患者中比非中性粒细胞减少症患者更常见，而金黄色葡萄球菌则较少见（5.9%比 15.6%，p < 0.001）。随着时间的推移，几种抗菌药物耐药率有所增加，在中性粒细胞减少症患者中比非中性粒细胞减少症患者更为常见，包括环丙沙星耐药大肠杆菌（94/758，12.4%比 42/506，8.3%，p = 0.021）、复方磺胺甲噁唑耐药大肠杆菌（366/764，47.9%比 191/517，36.9%，p < 0.001）、青霉素耐药链球菌（51/236，21.6%比 28/260，10.8%，p < 0.001）和万古霉素耐药肠球菌（46/250，18.4%比 9/144，6.3%，p < 0.001）。耐碳青霉烯类假单胞菌（OR 7.32，95%CI 2.78-19.32）和真菌，包括酵母和霉菌（OR 3.33，95%CI 2.02-5.48）与 30 天病例死亡率的最高比值比相关，经多变量逻辑回归分析。中性粒细胞减少症与生存相关（OR 0.66，95%CI 0.55-0.78）。根据中性粒细胞减少症的情况，BSI 流行病学存在差异，总体上随着时间的推移耐药性增加与不良结局相关。
