[血液系统疾病患者碳青霉烯类耐药肠杆菌科细菌血流感染的临床特征及预后分析]
[Clinical characteristics and prognostic analysis of carbapenem-resistant Enterobacteriaceae bloodstream infections in patients with hematologic diseases].
作者信息
Zhang L N, Cui Y Q, Lin Q S, Xu C H, Sun J L, Cao Y G, Cao W B, Liang C, Chen X, Zhai W H, Ma Q L, Zhang R L, Wei J L, Yang D L, Pang A M, He Y, Jiang E L, Han M Z, Feng S Z
机构信息
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 30l600, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2024 Nov 14;45(11):1022-1027. doi: 10.3760/cma.j.cn121090-20240822-00315.
This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors. This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed. A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% 36.2%, <0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% 33.3%, =0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% 34.1%, =0.012; 24 h: 40.8% 65.9%, =0.008). Multivariate analysis revealed that septic shock (=24.436, 95% 4.148 - 143.966, <0.001) and pulmonary infection (=9.346, 95% 2.718-32.140, <0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h (=0.225, 95% 0.059 - 0.851, =0.028), and treatment with the ceftazidime-avibactam-containing regimen (=0.082, 95% 0.018-0.362, =0.001) significantly reduced mortality. The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.
本研究旨在分析血液系统疾病患者中耐碳青霉烯类肠杆菌科细菌（CRE）血流感染（BSI）的临床和分子特征，并探索预后危险因素。这项回顾性研究纳入了2015年1月至2022年12月在血液学研究所和血液病医院发生CRE BSI的血液系统疾病患者。分析了临床特征、碳青霉烯酶检测结果、抗菌治疗及预后情况。共有120例患者发生CRE BSI。大肠埃希菌（58/120，48.3%）是最常见的肠杆菌科细菌，其次是肺炎克雷伯菌（52/120，43.3%）。共对93株CRE菌株进行了碳青霉烯酶检测，其中75株产生碳青霉烯酶（金属酶：51株；丝氨酸酶：24株）。BSI后30天死亡率为24.2%（29/120）。单因素分析显示，接受含头孢他啶-阿维巴坦方案治疗的患者死亡率显著低于接受其他抗生素治疗的患者（7.8%对36.2%，<0.001）。此外，在BSI发病24小时内开始积极治疗可显著降低死亡率（15.0%对33.3%，=0.019）。与未发生定植的患者相比，发生CRE定植的患者在12小时和24小时内接受积极治疗的比例显著更高（12小时：14.5%对34.1%，=0.012；24小时：40.8%对65.9%，=0.008）。多因素分析显示，感染性休克（=24.436，95% 4.148 - 143.966，<0.001）和肺部感染（=9.346，95% 2.718 - 32.140，<0.001）是30天内死亡的独立危险因素。在24小时内开始适当治疗（=0.225，95% 0.059 - 0.851，=0.028）以及采用含头孢他啶-阿维巴坦方案治疗（=0.082，95% 0.018 - 0.362，=0.001）可显著降低死亡率。血液系统疾病患者CRE BSI的预后较差。及时、适当的治疗以及采用含头孢他啶-阿维巴坦的方案可提高生存率和改善预后。
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