肿瘤血液学患者菌血症性皮肤和软组织感染的病因、抗生素治疗及结局

The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients.

作者信息

Castelli Valeria, Sastre-Escolà Enric, Puerta-Alcalde Pedro, Huete-Álava Leyre, Laporte-Amargós Júlia, Bergas Alba, Chumbita Mariana, Marín Mar, Domingo-Domenech Eva, Badia-Tejero Ana María, Pons-Oltra Paula, García-Vidal Carolina, Carratalà Jordi, Gudiol Carlota

机构信息

Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.

Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122 Milan, Italy.

出版信息

Antibiotics (Basel). 2023 Dec 13;12(12):1722. doi: 10.3390/antibiotics12121722.

DOI:10.3390/antibiotics12121722

PMID:38136755

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10740481/

Abstract

OBJECTIVES

to assess the current epidemiology, antibiotic therapy and outcomes of onco- hematological patients with bacteremic skin and soft-tissue infections (SSTIs), and to identify the risk factors for Gram-negative bacilli (GNB) infection and for early and overall mortality.

METHODS

episodes of bacteremic SSTIs occurring in cancer patients at two hospitals were prospectively recorded and retrospectively analyzed.

RESULTS

Of 164 episodes of bacteremic SSTIs, 53% occurred in patients with solid tumors and 47% with hematological malignancies. GNB represented 45.5% of all episodes, led by (37.8%). Multidrug resistance rate was 16%. Inadequate empirical antibiotic therapy (IEAT) occurred in 17.7% of episodes, rising to 34.6% in those due to resistant bacteria. Independent risk factors for GNB infection were corticosteroid therapy and skin necrosis. Early and overall case-fatality rates were 12% and 21%, respectively. Risk factors for early mortality were older age, septic shock, and IEAT, and for overall mortality were older age, septic shock and resistant bacteria.

CONCLUSIONS

GNB bacteremic SSTI was common, particularly if corticosteroid therapy or skin necrosis. IEAT was frequent in resistant bacteria infections. Mortality occurred mainly in older patients with septic shock, resistant bacteria and IEAT. These results might guide empirical antibiotic therapy in this high-risk population.

摘要

目的

评估肿瘤血液科患者发生菌血症性皮肤及软组织感染（SSTIs）的当前流行病学、抗生素治疗及转归，并确定革兰氏阴性杆菌（GNB）感染以及早期和总体死亡率的危险因素。

方法

前瞻性记录并回顾性分析两家医院癌症患者发生的菌血症性SSTIs发作情况。

结果

在164例菌血症性SSTIs发作中，53%发生于实体瘤患者，47%发生于血液系统恶性肿瘤患者。GNB占所有发作的45.5%，以[具体菌种未给出]为主（37.8%）。多重耐药率为16%。17.7%的发作存在经验性抗生素治疗不足（IEAT），在耐药菌所致发作中升至34.6%。GNB感染的独立危险因素为糖皮质激素治疗和皮肤坏死。早期和总体病死率分别为12%和21%。早期死亡的危险因素为高龄、感染性休克和IEAT，总体死亡的危险因素为高龄、感染性休克和耐药菌。