Zhang A, Qian C J, Wei R W, Jiang S, Fang J, Shi W, Xia L H
Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Feb 14;45(2):134-140. doi: 10.3760/cma.j.cn121090-20230731-00040.
To investigate the distribution and clinical characteristics of pathogenic bacteria following hematopoietic stem cell transplantation (HSCT), as well as to provide a preliminary research foundation for key microbial monitoring, and clinical diagnosis and treatment of infections after HSCT in hematological patients. We retrospectively analyzed the clinical data of 190 patients who tested positive for microbial testing [G-bacteria blood culture and/or carbapenem-resistant organism (CRO) screening of perianal swabs] at our center from January 2018 to December 2022. Patients were divided into blood culture positive, perianal swab positive, and double positive groups based on the testing results. The three patient groups underwent statistical analysis and comparison. The top four pathogenic bacteria isolated from sixty-three patients with G-bacteria bloodstream infection (BSI) were Escherichia coli (28 strains, 43.75% ), Klebsiella pneumonia (26 strains, 40.63% ), Pseudomonas aeruginosa (3 strains, 4.69% ), and Enterobacter cloacae (3 strains, 4.69% ). The top three pathogenic bacteria isolated from 147 patients with CRO perianal colonization were carbapenem-resistant Klebsiella pneumoniae (58 strains, 32.58% ), carbapenem-resistant Escherichia coli (49 strains, 27.53% ), and carbapenem-resistant Enterobacter cloacae (20 strains, 11.24% ). The 3-year disease-free survival (DFS ) and overall survival (OS) of double positive group patients were significantly lower compared to those in the blood culture and perianal swab positive groups (DFS: 35.6% 53.7% 68.6%, =0.001; OS: 44.4% 62.4% 76.9%, <0.001), while non-relapse mortality (NRM) was significantly higher (50.0% 34.9% 10.6%, <0.001). Failed engraftment of platelets and BSI are independent risk factors for NRM (<0.001). Using polymyxin and/or ceftazidime-avibactam for more than 7 days is an independent protective factor for NRM (=0.035) . This study suggests that the occurrence of BSI significantly increases the NRM after HSCT in patients with hematological diseases; CRO colonization into the bloodstream has a significant impact on the DFS and OS of HSCT patients.
为探讨造血干细胞移植（HSCT）后病原菌的分布及临床特征，为血液系统疾病患者HSCT后关键微生物监测及感染的临床诊断与治疗提供初步研究基础。我们回顾性分析了2018年1月至2022年12月在本中心微生物检测呈阳性[革兰阴性菌血培养和/或肛周拭子碳青霉烯耐药菌（CRO）筛查]的190例患者的临床资料。根据检测结果将患者分为血培养阳性组、肛周拭子阳性组和双阳性组。对三组患者进行统计分析和比较。从63例革兰阴性菌血流感染（BSI）患者中分离出的前四位病原菌为大肠埃希菌（28株，43.75%）、肺炎克雷伯菌（26株，40.63%）、铜绿假单胞菌（3株，4.69%）和阴沟肠杆菌（3株，4.69%）。从147例CRO肛周定植患者中分离出的前三位病原菌为耐碳青霉烯肺炎克雷伯菌（58株，32.58%）、耐碳青霉烯大肠埃希菌（49株，27.53%）和耐碳青霉烯阴沟肠杆菌（20株，11.24%）。双阳性组患者的3年无病生存率（DFS）和总生存率（OS）显著低于血培养阳性组和肛周拭子阳性组（DFS：35.6% 53.7% 68.6%，P =0.001；OS：44.4% 62.4% 76.9%，P<0.001），而非复发死亡率（NRM）显著更高（50.0% 34.9% 10.6%，P<0.001）。血小板植入失败和BSI是NRM的独立危险因素（P<0.001）。使用多黏菌素和/或头孢他啶-阿维巴坦超过7天是NRM的独立保护因素（P =0.035）。本研究表明，血液系统疾病患者HSCT后BSI的发生显著增加NRM；CRO定植入血对HSCT患者的DFS和OS有显著影响。
