Han Mei, Hua Miaomiao, Xie Hui, Li Jia, Wang Yijun, Shen Han, Cao Xiaoli
Department of Laboratory Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China.
Nanjing Field Epidemiology Training Program, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, People's Republic of China.
Infect Drug Resist. 2025 Jan 22;18:427-440. doi: 10.2147/IDR.S502509. eCollection 2025.
This study aimed to analyze the antimicrobial resistance profiles, clinical characteristics and risk factors of bacteremia caused by complex (ECC) strains.
We retrospectively collected clinical data from patients diagnosed with ECC bacteremia between 2013 and 2022 in a tertiary hospital in Jiangsu. Subgroup analyses were performed based on multidrug resistance (MDR), nosocomial acquisition, polymicrobial bacteremia, and mortality.
Among 188 ECC strains, the highest resistance was to ceftriaxone (39.9%), followed by ceftazidime (36.7%) and aztreonam (31.2%), with low resistance to carbapenems (<8.6%) and amikacin (1.6%). MDR ECC accounted for 30.9% (58/188). Previous antibiotic therapy was an independent risk factor for MDR ECC (OR = 3.193, < 0.020), while appropriate antibiotic therapy significantly reduced the risk (OR = 0.279, < 0.001). ICU admission was an independent risk factor for polymicrobial bacteremia, both endoscopy and blood transfusion were associated with mortality.
Carbapenems and amikacin are the most effective treatments for ECC bacteremia. Previous antibiotic therapy increases the risk of MDR ECC, while appropriate antibiotic therapy reduces it. ICU admission is an independent risk factor for polymicrobial bacteremia, both endoscopy and blood transfusion are linked to higher mortality. Effective control of MDR ECC bacteremia requires comprehensive strategies, including resistance detection, risk factor identification, and infection prevention.
本研究旨在分析复杂（ECC）菌株引起的菌血症的抗菌药物耐药谱、临床特征及危险因素。
我们回顾性收集了2013年至2022年期间在江苏一家三级医院诊断为ECC菌血症患者的临床资料。基于多重耐药（MDR）、医院获得性感染、多微生物菌血症和死亡率进行亚组分析。
在188株ECC菌株中，对头孢曲松的耐药率最高（39.9%），其次是头孢他啶（36.7%）和氨曲南（31.2%），对碳青霉烯类药物（<8.6%）和阿米卡星（1.6%）的耐药率较低。MDR ECC占30.9%（58/188）。既往抗生素治疗是MDR ECC的独立危险因素（OR = 3.193，<0.020），而适当的抗生素治疗可显著降低风险（OR = 0.279，<0.001）。入住重症监护病房（ICU）是多微生物菌血症的独立危险因素，内镜检查和输血均与死亡率相关。
碳青霉烯类药物和阿米卡星是治疗ECC菌血症最有效的药物。既往抗生素治疗会增加MDR ECC的风险，而适当的抗生素治疗则可降低该风险。入住ICU是多微生物菌血症的独立危险因素，内镜检查和输血均与较高的死亡率相关。有效控制MDR ECC菌血症需要综合策略，包括耐药性检测、危险因素识别和感染预防。
