Sallah Ya Haddy, Bratti Vanessa F, Rafinejad-Farahani Bahar, Jayasekar Zurn Shalini, Johnson Sonali, Crestani André S, Dacoregio Maria I, Majeed Haris, Fazelzad Rouhi, Pabani Aliyah, Wilson Brooke E, Favorito Fernanda M, de Moraes Fabio Ynoe, Sung Lillian, Martei Yehoda M, Rodin Danielle
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Public Health Sciences, Queen's University, Kingston, ON, Canada; Global Cancer Program, Toronto, ON, Canada.
Lancet Oncol. 2025 May;26(5):e242-e252. doi: 10.1016/S1470-2045(25)00079-8.
Antimicrobial resistance (AMR) is a substantial global health threat. Patients with haematological malignancies have an increased risk of AMR infection due to disease-related and treatment-related immunosuppression. This scoping review searched four bibliographic databases from Jan 1, 2000, to Dec 7, 2023, for publications on AMR bacterial infections in patients with haematological malignancies and identified 274 eligible articles. AMR prevalence data extraction focused on WHO bacterial priority pathogens. The prevalence of AMR bacterial infections from seven WHO priority pathogens in patients with haematological malignancies was 35% (95% CI 30-40; I 99·4%). The most frequent AMR infections reported were bloodstream infections, with the highest reported AMR pathogens in third-generation cephalosporin-resistant Enterobacterales (pooled prevalence rate 44% [95% CI 23-64; I 99·8%]), meticillin-resistant Staphylococcus aureus (43% [31-54; I 95·9%]), and vancomycin-resistant enterococci (41% [26-56; I 96·2%]). 53 (65%) of the 81 studies that reported mortality showed higher mortality rates associated with AMR infections. 168 (61%) studies were conducted in high-income countries, with no studies published from the WHO Africa region, revealing a substantial data gap from low-income and middle-income regions. Future efforts should prioritise standardised reporting measures, robust surveillance, antimicrobial stewardship, and well designed clinical trials, particularly in under-represented regions, to mitigate the effect of AMR on cancer care.
抗菌药物耐药性（AMR）是对全球健康的重大威胁。血液系统恶性肿瘤患者由于疾病相关和治疗相关的免疫抑制，发生AMR感染的风险增加。本综述检索了2000年1月1日至2023年12月7日的四个文献数据库，以查找关于血液系统恶性肿瘤患者AMR细菌感染的出版物，并确定了274篇符合条件的文章。AMR患病率数据提取聚焦于世界卫生组织（WHO）的重点细菌病原体。血液系统恶性肿瘤患者中七种WHO重点病原体的AMR细菌感染患病率为35%（95%置信区间30 - 40；I 99.4%）。报告的最常见AMR感染是血流感染，报告的AMR病原体中第三代头孢菌素耐药肠杆菌科细菌最为常见（合并患病率44% [95%置信区间23 - 64；I 99.8%]），耐甲氧西林金黄色葡萄球菌（43% [31 - 54；I 95.9%]），以及耐万古霉素肠球菌（41% [26 - 56；I 96.2%]）。在报告死亡率的81项研究中，有53项（65%）显示AMR感染相关的死亡率更高。168项（61%）研究在高收入国家进行，WHO非洲区域没有发表相关研究，这表明低收入和中等收入地区存在大量数据缺口。未来的工作应优先考虑标准化报告措施、强有力的监测、抗菌药物管理以及精心设计的临床试验，特别是在代表性不足的地区，以减轻AMR对癌症治疗的影响。
