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实体器官癌症患者的菌血症:对流行病学和抗生素使用情况的见解

Bacteremia in Patients with Solid Organ Cancer: Insights into Epidemiology and Antibiotic Consumption.

作者信息

de Dios-García Begoña, Maestro Guillermo, Díaz-Pedroche Carmen, Parra Wagner, Campos Óscar, Orellana María Ángeles, Caro José Manuel, Lumbreras Carlos, Lizasoain Manuel

机构信息

Internal Medicine Department, Universitary Hospital "12 de Octubre", Av Córdoba, 28041 Madrid, Spain.

Oncology Department, Universitary Hospital "12 de Octubre", Av Córdoba, 28041 Madrid, Spain.

出版信息

Cancers (Basel). 2023 Nov 24;15(23):5561. doi: 10.3390/cancers15235561.

Abstract

Epidemiology and risk factors associated to bacterial resistance in solid organ cancer (SOC) patients has been barely described. This retrospective monocentric study analyzed clinical variables in SOC patients who developed bacteremia between 1 January 2019 and 31 December 2022. We described rates of bacterial resistance in Gram negative bacteria (80.6%): , Carbapenem-Resistant and Meropenem-Resistant as well as antibiotic consumption, and compared these rates between the medical and oncology wards. In total, we included 314 bacteremias from 253 patients. SOC patients are frequently prescribed antibiotics (40.8%), mainly fluoroquinolones. Nosocomial bacteremia accounted for 18.2% of the cases and only 14.3% of patients were neutropenic. Hepatobiliary tract was the most frequent tumor (31.5%) and source of bacteremia (38.5%). Resistant bacteria showed a decreased rate of resistance during the years studied in the oncology ward. Both K-ESBL and K-CBP resistance rates decreased (from 45.8% to 20.0%, and from 29.2% to 20.0%, respectively), as well as MRPA, which varied from a resistance rate of 28% to 16.7%. The presence of a urinary catheter ( < 0.001) and previous antibiotic prescription ( = 0.002) were risk factors for bacterial resistance. Identifying either of these risk factors could help in guiding antibiotic prescription for SOC patients.

摘要

实体器官癌症(SOC)患者中与细菌耐药性相关的流行病学和风险因素鲜有描述。这项回顾性单中心研究分析了2019年1月1日至2022年12月31日期间发生菌血症的SOC患者的临床变量。我们描述了革兰氏阴性菌(80.6%)中的细菌耐药率,包括耐碳青霉烯类和耐美罗培南类,以及抗生素使用情况,并比较了内科病房和肿瘤科病房之间的这些比率。我们总共纳入了253例患者的314次菌血症病例。SOC患者经常使用抗生素(40.8%),主要是氟喹诺酮类。医院获得性菌血症占病例的18.2%,只有14.3%的患者为中性粒细胞减少。肝胆道是最常见的肿瘤(31.5%)和菌血症来源(38.5%)。在研究期间,肿瘤科病房中耐药菌的耐药率有所下降。K-ESBL和K-CBP耐药率均下降(分别从45.8%降至20.0%和从29.2%降至20.0%),耐甲氧西林金黄色葡萄球菌(MRPA)也是如此,其耐药率从28%降至16.7%。留置导尿管(P<0.001)和既往抗生素使用史(P = 0.002)是细菌耐药的风险因素。识别这些风险因素中的任何一个都有助于指导SOC患者的抗生素使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0a4e/10705097/4d1d8a7e816a/cancers-15-05561-g001.jpg

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