血液系统疾病患者大肠埃希菌和肺炎克雷伯菌血流感染的抗生素管理：评估短疗程和碳青霉烯类药物节省策略。
Antibiotic stewardship in hematological patients with Escherichia coli and Klebsiella pneumoniae bloodstream infections: evaluating short-course and carbapenem-sparing strategies.
作者信息
Cui Yuqing, Feng Xiaomeng, Pan Ling, Lin Qingsong, Wang Jieru, Zhen Sisi, Fan Yuping, Chen Xin, Zheng Yizhou, Mi Yingchang, Zhang Fengkui, Zhu Xiaofan, Xiao Zhijian, Jiang Erlie, Han Mingzhe, Wang Jianxiang, Feng Sizhou
机构信息
State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Tianjin Institutes of Health Science, Tianjin, China.
出版信息
Ann Clin Microbiol Antimicrob. 2025 May 29;24(1):34. doi: 10.1186/s12941-025-00801-y.
BACKGROUND
To address the overuse of antibiotics, this study examined the clinical characteristics and outcomes associated with antibiotic duration and carbapenem-sparing regimens in hematological patients with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bloodstream infections (BSI).
METHODS
We conducted a retrospective analysis of hematological patients with E. coli or K. pneumoniae BSI from 2017 to 2023. Propensity score matching (PSM) controlled for confounding variables, and data were analyzed using multivariate regression models.
RESULTS
A total of 1,862 patients were included (E. coli: n = 932; K. pneumoniae: n = 930). Among 1,105 patients in the antibiotic duration cohort, 48.96% (n = 541) received short-course therapy (median: 8 days, IQR: 7-9), while others received prolonged-course therapy (median: 14 days, IQR: 12-17). No significant differences in 30-day mortality or 90-day recurrence rates were observed between the two groups, either before or after PSM. In the antibiotic regimen cohort (n = 1,606), we assessed the effectiveness of carbapenem-containing versus carbapenem-sparing regimens, as well as monotherapy versus combination therapy. Among 1,488 patients with non-carbapenem-resistant Enterobacteriaceae (non-CRE) infections, 567 had infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. In this subgroup, 30-day mortality rates also showed no significant differences between carbapenem-containing and carbapenem-sparing regimens, both before and after PSM.
CONCLUSION
In conclusion, short-course antibiotic therapy is as effective as prolonged therapy for treating E. coli and K. pneumoniae BSI in hematological patients. Similarly, carbapenem-sparing regimens are non-inferior to carbapenem-based regimens. These findings highlight the potential for optimizing antibiotic use, but further validation through randomized controlled trials is warranted.
背景
为解决抗生素过度使用问题，本研究调查了血液系统患者感染大肠埃希菌（E. coli）和肺炎克雷伯菌（K. pneumoniae）血流感染（BSI）时，抗生素使用时长及碳青霉烯类药物节省方案的临床特征和结局。
方法
我们对2017年至2023年期间发生E. coli或K. pneumoniae BSI的血液系统患者进行了回顾性分析。倾向评分匹配（PSM）用于控制混杂变量，并使用多变量回归模型分析数据。
结果
共纳入1862例患者（E. coli：n = 932；K. pneumoniae：n = 930）。在抗生素使用时长队列的1105例患者中，48.96%（n = 541）接受短程治疗（中位数：8天，四分位间距：7 - 9天），其余患者接受长程治疗（中位数：14天，四分位间距：12 - 17天）。在PSM前后，两组的30天死亡率或90天复发率均无显著差异。在抗生素方案队列（n = 1606）中，我们评估了含碳青霉烯类方案与碳青霉烯类药物节省方案以及单药治疗与联合治疗的有效性。在1488例非耐碳青霉烯类肠杆菌科细菌（non-CRE）感染患者中，567例感染由产超广谱β-内酰胺酶（ESBL）细菌引起。在该亚组中，PSM前后含碳青霉烯类方案与碳青霉烯类药物节省方案的30天死亡率也无显著差异。
结论
总之，短程抗生素治疗在治疗血液系统患者的E. coli和K. pneumoniae BSI方面与长程治疗同样有效。同样，碳青霉烯类药物节省方案不劣于基于碳青霉烯类的方案。这些发现凸显了优化抗生素使用的潜力，但仍需通过随机对照试验进行进一步验证。
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