Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fuzhou, China.
Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China.
Front Cell Infect Microbiol. 2024 Sep 26;14:1471477. doi: 10.3389/fcimb.2024.1471477. eCollection 2024.
Carbapenem-resistant (CRE) bloodstream infections (BSIs) pose a significant risk to patients with hematologic malignancies, yet the distinct features and outcomes of these infections are not thoroughly understood.
This retrospective study examined the characteristics and clinical outcomes of patients with BSIs at the Hematology Department of Fujian Medical University Union Hospital from 2018 to 2022. Whole-genome sequencing was conducted on 45 consecutive CRE BSI isolates during this period.
A total of 301 patients with BSIs were included, with 65 (21.6%) cases of CRE and 236 (78.4%) cases of carbapenem-susceptible (CSE). CRE infections accounted for 16.9% to 26.9% of all BSIs, and carbapenem-resistant (CRKP) was the predominant strain. The most frequent sequence type (ST) and carbapenemase among CRKP were ST11 (68.6%) and KPC-2 (80.0%), respectively. Perianal infections, multiple infection foci, and a history of multiple hospitalizations, ICU stays, and prior CRE infections were identified as risk factors for CRE BSIs. Patients in the CRE group experienced significantly higher proportions of infection-related septic shock (43.1% vs. 19.9%, P < 0.0003) and 30-day all-cause mortality (56.9% vs. 24.6%, P < 0.0001) compared to those in the CSE group. Patient's age and disease subtypes, strain subtypes, and antimicrobial treatment regimens significantly influenced survival in patients with CRE BSIs.
CRE BSIs are a frequent complication in patients with hematological malignancies undergoing treatment and are associated with poor survival rates. A comprehensive understanding of risk factors and ongoing surveillance of prevalent strains are essential for the effective management of these infections.
耐碳青霉烯类肠杆菌科细菌（CRE）血流感染（BSI）对血液系统恶性肿瘤患者构成重大威胁，但此类感染的独特特征和结局尚不完全清楚。
本回顾性研究分析了 2018 年至 2022 年期间福建医科大学附属协和医院血液科发生的 BSI 患者的特征和临床结局。在此期间对 45 例连续 CRE BSI 分离株进行了全基因组测序。
共纳入 301 例 BSI 患者，其中 65 例（21.6%）为 CRE 感染，236 例（78.4%）为碳青霉烯敏感（CSE）感染。CRE 感染占所有 BSI 的 16.9%至 26.9%，耐碳青霉烯（CRKP）是主要流行株。CRKP 中最常见的序列型（ST）和碳青霉烯酶分别为 ST11（68.6%）和 KPC-2（80.0%）。肛周感染、多部位感染灶、多次住院、入住 ICU 及既往 CRE 感染史是 CRE BSI 的危险因素。与 CSE 组相比，CRE 组患者感染相关败血症休克（43.1% vs. 19.9%，P<0.0003）和 30 天全因死亡率（56.9% vs. 24.6%，P<0.0001）的比例更高。患者年龄、疾病亚型、菌株亚型和抗菌治疗方案显著影响 CRE BSI 患者的生存情况。
CRE BSI 是血液系统恶性肿瘤患者治疗过程中的常见并发症，与生存率低相关。全面了解危险因素并持续监测流行株对于此类感染的有效管理至关重要。
