de Souza Ingvar Ludwig Augusto, Cappellano Paola, Ferreira Diogo Boldim, Bergamasco Maria Daniela, das Chagas Neto Thomas Cardoso, Kerbauy Fabio Rodrigues, Baiocchi Otavio Carvalho Guimarães, Pignatari Antonio Carlos Campos
Disciplina de Infectologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil.
Hcor-Hospital do Coracao, Sao Paulo, Brazil.
PLoS One. 2024 Jan 26;19(1):e0297161. doi: 10.1371/journal.pone.0297161. eCollection 2024.
Bacterial bloodstream infections (BSI) are a common threat among patients with haematological malignancies (HM) and hematopoietic stem cell transplant recipients (HSCT). The purpose of this research was to describe clinical and microbiological aspects of BSI caused by carbapenem-resistant Klebsiella pneumoniae (CRKp) and assess risk factors associated with 30-day mortality in a 10-year cohort of haematological patients. A total of 65 CRKp-BSI episodes occurring in HM patients and HSCT recipients and CRKp-BSI between January 2010 and December 2019 were retrospectively studied. Acute leukemias were the most frequently observed underlying disease (87.7%) and 18 patients (27.7%) received HSCT. Mucosal barrier injury in the gastrointestinal tract was the primary cause of bacteremia (86.1%). Also, 14 individuals (21.6%) had an Invasive Fungal Disease (IFD) throughout the episode. Regarding treatment, in 31 patients (47.7%) empirical therapy was deemed appropriate, whereas 33 (50.8%) patients received a combination therapy. Microbiological data revealed that the majority of isolates (53-58%) had the Polymyxin B co-resistance phenotype, while amikacin resistance was less common (16 samples, or 24.7%). The mortality rates at 14 and 30 days were 32.3% and 36.9%, respectively. In a multivariate Cox regression analysis, prompt appropriate antibiotic administration within three days was associated with a better outcome (Adjusted Hazard Ratio [aHR]: 0.33; 95% Confidence Interval [CI]: 0.14-0.76; p = 0.01), whereas hypotension at presentation (aHR: 3.88; 95% CI: 1.40-10.74; p = 0.01) and concurrent IFD (aHR: 2.97; 95% CI: 1.20-7.37; p = 0.02) were independently associated with death within 30 days. Additionally, a favorable correlation between combination therapy and overall survival was found (aHR: 0.18; 95%CI: 0.06-0.56; p = 0.002). In conclusion, 30-day mortality CRKp-BSI was elevated and most of the isolates were polymyxin B resistant. Early appropriate antimicrobial treatment and the use of combination therapy were linked to a better outcome.
细菌血流感染（BSI）是血液系统恶性肿瘤（HM）患者和造血干细胞移植受者（HSCT）面临的常见威胁。本研究的目的是描述耐碳青霉烯肺炎克雷伯菌（CRKp）引起的BSI的临床和微生物学特征，并评估10年血液系统疾病患者队列中与30天死亡率相关的危险因素。对2010年1月至2019年12月期间发生在HM患者和HSCT受者中的65例CRKp-BSI发作以及CRKp-BSI进行了回顾性研究。急性白血病是最常见的基础疾病（87.7%），18例患者（27.7%）接受了HSCT。胃肠道黏膜屏障损伤是菌血症的主要原因（86.1%）。此外，14例患者（21.6%）在整个病程中患有侵袭性真菌病（IFD）。关于治疗，31例患者（47.7%）的经验性治疗被认为是合适的，而33例患者（50.8%）接受了联合治疗。微生物学数据显示，大多数分离株（53-58%）具有多黏菌素B共耐药表型，而阿米卡星耐药则较少见（16份样本，占24.7%）。14天和30天的死亡率分别为32.3%和36.9%。在多变量Cox回归分析中，在三天内及时给予适当的抗生素与更好的预后相关（调整后风险比[aHR]：0.33；95%置信区间[CI]：0.14-0.76；p = 0.01），而就诊时低血压（aHR：3.88；95%CI：1.40-10.74；p = 0.01）和并发IFD（aHR：2.97；95%CI：1.20-7.37；p = 0.02）与30天内死亡独立相关。此外，发现联合治疗与总生存之间存在良好的相关性（aHR：0.18；95%CI：0.06-0.56；p = 0.002）。总之，CRKp-BSI的30天死亡率升高，大多数分离株对多黏菌素B耐药。早期适当的抗菌治疗和联合治疗的使用与更好的预后相关。
