Kessel Johanna, Bug Gesine, Steffen Björn, Brunnberg Uta, Vehreschild Maria J G T, Weber Sarah, Scheich Sebastian, Lang Fabian, Serve Hubert, Herrmann Eva, Hogardt Michael
Department of Internal Medicine 2, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Theodor Stern-Kai 7, 60590, Frankfurt, Germany.
Department of Medicine 2, Hematology/Oncology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor Stern-Kai 7, 60590, Frankfurt, Germany.
Infection. 2025 Aug;53(4):1383-1392. doi: 10.1007/s15010-024-02453-0. Epub 2024 Dec 19.
Bloodstream infections caused by Pseudomonas aeruginosa (PABSI) in hematological patients are associated with high morbidity and mortality. We investigated the epidemiology, risk factors, and outcomes of PABSI at our center.
All adult hematological patients with PABSI between January 2013 and July 2023 were included. Demographic and clinical characteristics, antimicrobial susceptibilities, antibiotic therapy, fluoroquinolone-prophylaxis, source of infection, and 30-day outcome were recorded. Descriptive statistics, tests for difference, and logistic regression models were performed.
Fifty patients with PABSI were identified with a median age of 58.5 years (range 24-78). 37 patients (74%) had severe neutropenia, 20 (40%) received allogeneic HSCT, and 29 (58%) had acute leukemia. A total of 34 (68%) had received timely appropriate anti-pseudomonal antibiotic therapy. The most common presumed cause of PABSI was mucositis (n = 16, 32%), followed by pneumonia (8, 16%) and skin and soft tissue infections (n = 6, 12%). Empirical combination therapy was used in 16 (32%) patients, while targeted combination therapies were used in 27 (54%) patients. P. aeruginosa detection led to treatment change in 31 (62%) cases. The overall 30-day survival rate was 78% (n = 39). Carbapenem-resistance occurred in 34% (n = 17), and multidrug-resistance (MDR) in 20% (n = 10). Prior antibiotic exposure was associated with resistance. Appropriate antibiotic therapy was associated with survival, whereas antibiotic resistance and organ infection were associated with a fatal outcome.
Prior antibiotic exposure in hematological patients is associated with resistance in PABSI, which is a major risk factor for a fatal outcome. Antibiotic stewardship efforts should be intensified and fluoroquinolone prophylaxis needs to be reconsidered.
铜绿假单胞菌引起的血流感染（PABSI）在血液学患者中与高发病率和死亡率相关。我们调查了我院PABSI的流行病学、危险因素和结局。
纳入2013年1月至2023年7月期间所有患有PABSI的成年血液学患者。记录人口统计学和临床特征、抗菌药物敏感性、抗生素治疗、氟喹诺酮预防、感染源和30天结局。进行描述性统计、差异检验和逻辑回归模型分析。
共确定50例PABSI患者，中位年龄58.5岁（范围24 - 78岁）。37例（74%）有严重中性粒细胞减少，20例（40%）接受异基因造血干细胞移植，29例（58%）患有急性白血病。共有34例（68%）接受了及时恰当的抗假单胞菌抗生素治疗。PABSI最常见的推测病因是粘膜炎（n = 16，32%），其次是肺炎（8例，16%）和皮肤及软组织感染（n = 6，12%）。16例（32%）患者采用经验性联合治疗，27例（54%）患者采用靶向联合治疗。31例（62%）病例因检测到铜绿假单胞菌而改变治疗方案。30天总生存率为78%（n = 39）。34%（n = 17）出现碳青霉烯类耐药，20%（n = 10）出现多重耐药（MDR）。既往抗生素暴露与耐药相关。恰当的抗生素治疗与生存相关，而抗生素耐药和器官感染与致命结局相关。
血液学患者既往抗生素暴露与PABSI耐药相关，这是致命结局的主要危险因素。应加强抗生素管理，并重新考虑氟喹诺酮预防措施。
