Li Liubing, Chen Dubo, Liu Pingjuan, Dai Luqi, Tang Zhaoxia, Yi Siting, Ye Mengmin
Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Infect Drug Resist. 2024 Dec 20;17:5699-5706. doi: 10.2147/IDR.S484546. eCollection 2024.
Bloodstream infections (BSIs) caused by (AB), especially carbapenem-resistant (CRAB), can lead to a high patient mortality rate.
This study aimed to analyze the clinical data and prognosis of 191 patients with AB-BSI hospitalized in Southern China from January 2017 to December 2023.
CRAB was diagnosed in 128 (67.0%) of the 191 patients with AB-BSI. Endotracheal intubation (OR = 23.957, 95% CI: 5.123-112.022, P < 0.001), carbapenem treatment (OR = 6.422, 95% CI: 1.554-26.542, P = 0.010) and ≥2 antimicrobial drugs therapy (OR = 6.131, 95% CI: 1.763-21.324, P = 0.004) prior to the onset of BSI were independent risk factors for the development of CRAB-BSI, as revealed by the binary logistic regression analysis. The overall mortality rate of patients with AB-BSI was 27.7%, while that of patients with CRAB was significantly higher than that of patients with carbapenem-sensitive (CSAB) (39.1% vs 4.8%, P < 0.001). Multivariate Cox regression analysis revealed septic shock (HR = 3.664, 95% CI: 1.537-8.736, P = 0.003) as an independent risk factor for mortality in CRAB-BSI patients. Kaplan-Meier survival analysis showed a significantly lower 28-day survival rate for CRAB-BSI patients who developed septic shock compared to those who did not (58.4% vs 87.1%, P = 0.001).
Clinicians should closely monitor patients at high risk for CRAB-BSI, focusing on invasive procedure management and antimicrobial stewardship. Timely supportive care is crucial for CRAB-BSI patients at risk of septic shock to improve survival outcomes.
由鲍曼不动杆菌（AB）引起的血流感染（BSIs），尤其是耐碳青霉烯类鲍曼不动杆菌（CRAB），可导致患者高死亡率。
本研究旨在分析2017年1月至2023年12月在中国南方住院的191例AB-BSI患者的临床资料和预后。
191例AB-BSI患者中，128例（67.0%）诊断为CRAB。二元逻辑回归分析显示，气管插管（OR = 23.957，95%CI：5.123 - 112.022，P < 0.001）、碳青霉烯类治疗（OR = 6.422，95%CI：1.554 - 26.542，P = 0.010）以及BSI发作前使用≥2种抗菌药物治疗（OR = 6.131，95%CI：1.763 - 21.324，P = 0.004）是CRAB-BSI发生的独立危险因素。AB-BSI患者的总体死亡率为27.7%，而CRAB患者的死亡率显著高于碳青霉烯类敏感鲍曼不动杆菌（CSAB）患者（39.1%对4.8%，P < 0.001）。多因素Cox回归分析显示，感染性休克（HR = 3.664，95%CI：1.537 - 8.736，P = 0.003）是CRAB-BSI患者死亡的独立危险因素。Kaplan-Meier生存分析显示，发生感染性休克的CRAB-BSI患者28天生存率显著低于未发生感染性休克的患者（58.4%对87.1%，P = 0.001）。
临床医生应密切监测CRAB-BSI高危患者，重点关注侵入性操作管理和抗菌药物管理。及时的支持性治疗对于有感染性休克风险的CRAB-BSI患者改善生存结局至关重要。
