癌症患者耐碳青霉烯类血流感染的临床特征、危险因素及预后：在一家三级癌症医院进行的8年回顾性研究
Clinical Characteristics, Risk Factors and Prognosis of Carbapenem-Resistant Bloodstream Infections in Cancer Patients: An 8-year Retrospective Study in a Tertiary Cancer Hospital.
作者信息
Jing Min, Wang Xiaokun, Li Wenjiao, Sun Mingyue, Chang Yanmin, Xiao Weiqiang, Xu Qingxia, Zhang Xuefei
机构信息
Department of Clinical Laboratory, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, People's Republic of China.
Zhengzhou Key Laboratory of Digestive System Tumor Marker Diagnosis, Zhengzhou, 450008, People's Republic of China.
出版信息
Infect Drug Resist. 2025 May 15;18:2511-2524. doi: 10.2147/IDR.S515530. eCollection 2025.
PURPOSE
To ascertain clinical characteristics, risk factors and prognosis of bloodstream infection (BSI) caused by carbapenem-resistant (CRPA) among cancer patients with solid tumors (ST) and hematological malignancies (HM).
METHODS
A retrospective study (January 2015 to December 2023) was performed on the health records of cancer patients with (PA) BSI at a tertiary cancer hospital in China. Ninety-two CRPA BSI cases were randomly paired with contemporaneous carbapenem-sensitive (CSPA) BSI cases at a ratio of 1:1. Multivariate logistic regression analysis was performed to identify risk factors associated with the development of CRPA BSI and Cox regression for mortality rates. Survival probability was evaluated using the Kaplan-Meier estimator. Between-group survival differences were analyzed using the Log rank test and Hazard ratios (HR) were calculated to quantify mortality risk disparities.
RESULTS
A total of 361 cancer patients with PA BSI were included, 25.5% (92/361) of which were infected with CRPA. Among the 184 enrolled patients (48 with ST, 136 with HM), the independent risk factors for developing CRPA BSI were platelet counts and recent carbapenem use within 90 days in patients with ST. Presence of multidrug-resistant (MDRPA) and exposure to carbapenems within 90 days were the risk factors for developing CRPA BSI in patients with HM. The 30-day mortality of CRPA BSI was 37.5% and 35.3% in patients with ST and HM, respectively. Additionally, higher Pitt bacteremia score (PBS) was distinctly associated with increased 30-day mortality in cancer patients suffering from CRPA BSI (HR 1.672, 95% CI 1.309-2.135, < 0.001).
CONCLUSION
The mortality rates of CRPA BSI are notably high in both patients with ST and HM. The risk factors for CRPA BSI and mortality may guide and optimize the management of CRPA BSI in cancer patients.
目的
确定实体瘤（ST）和血液系统恶性肿瘤（HM）癌症患者中耐碳青霉烯类肺炎克雷伯菌（CRPA）引起的血流感染（BSI）的临床特征、危险因素和预后。
方法
对中国一家三级癌症医院癌症患者（PA）BSI的健康记录进行回顾性研究（2015年1月至2023年12月）。92例CRPA BSI病例与同期碳青霉烯类敏感（CSPA）BSI病例按1:1的比例随机配对。进行多变量逻辑回归分析以确定与CRPA BSI发生相关的危险因素，并进行Cox回归分析死亡率。使用Kaplan-Meier估计器评估生存概率。使用对数秩检验分析组间生存差异，并计算风险比（HR）以量化死亡风险差异。
结果
共纳入361例PA BSI癌症患者，其中25.5%（92/361）感染CRPA。在184例纳入患者中（48例ST患者，136例HM患者），ST患者发生CRPA BSI的独立危险因素是血小板计数和90天内近期使用碳青霉烯类药物。耐多药肺炎克雷伯菌（MDRPA）的存在和90天内接触碳青霉烯类药物是HM患者发生CRPA BSI的危险因素。ST和HM患者中CRPA BSI的30天死亡率分别为37.5%和35.3%。此外，较高的皮特菌血症评分（PBS）与CRPA BSI癌症患者30天死亡率增加明显相关（HR 1.672，95%CI 1.309-2.135，<0.001）。
结论
ST和HM患者中CRPA BSI的死亡率均显著较高。CRPA BSI的危险因素和死亡率可能指导并优化癌症患者CRPA BSI的管理。
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