多重耐药对革兰氏阴性杆菌所致血流感染癌症患者的影响：一项多中心研究结果

Impact of multidrug resistance in cancer patients with bloodstream infections caused by Gram-negative bacilli: results from a multicentre study.

作者信息

Falcone Marco, Carbonara Sergio, Marino Andrea, Di Caprio Giovanni, Carretta Anna, Mularoni Alessandra, Mariani Michele Fabiano, Maraolo Alberto Enrico, Dalfino Lidia, Corbo Lorenzo, Medaglia Alice Annalisa, Sgroi Christian, Del Vecchio Rosa Fontana, Ceccarelli Giancarlo, Albanese Antonio, Buscemi Calogero, Talamanca Simona, Foti Giuseppe, Franco Antonina, Iacobello Carmelo, Corrao Salvatore, Morana Domenico, Pieralli Filippo, Gentile Ivan, Santantonio Teresa, Cascio Antonio, Coppola Nicola, Cacopardo Bruno, Venditti Mario, Menichetti Francesco, Tiseo Giusy

机构信息

Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Street Paradisa 2, Pisa 56124, Italy.

Infectious Disease Unit, Ospedale V. Emanuele II, Bisceglie (BT), Italy.

出版信息

JAC Antimicrob Resist. 2025 Jul 4;7(4):dlaf116. doi: 10.1093/jacamr/dlaf116. eCollection 2025 Aug.

DOI:10.1093/jacamr/dlaf116

PMID:40625711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12231543/

Abstract

OBJECTIVE

To evaluate the impact of multidrug resistance (MDR) on the mortality of cancer patients with bloodstream infection (BSI) by Gram-negative bacilli (GNB).

PATIENTS AND METHODS

This was a prospective observational multicentre study including cancer patients with BSI caused by GNB (June 2018-January 2020). The primary outcome was 30-day mortality. The secondary outcome was mortality attributable to MDR organisms, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant (CR) Enterobacterales and CR non-fermenting GNB (CR-NFGNB). A multivariable regression analysis identified factors associated with 30-day mortality. Adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) were calculated. Attributable mortality was estimated according to DRIVE-AB Consortium's formula.

RESULTS

Of 347 cancer patients, 232 (66.9%) had BSI caused by MDR-GNB. Thirty-day mortality was 27.2% in patients with BSI caused by MDR organisms compared to 7% in those with BSI by susceptible GNB ( < 0.001). In the multivariable analysis, MDR-GNB including ESBL-producing Enterobacterales (aOR 8.734, 95% CI 1.411-54.077, = 0.02), KPC-producing Enterobacterales (aOR 8.548, 95% CI 1.296-56.411, = 0.026), metallo-β-lactamases (MBL)-producing Enterobacterales (aOR 15.802, 95% CI 1.408-68.667, = 0.022) and CR-NFGNB (aOR 53.373, 95% CI 5.104-89.146, < 0.001) as compared to susceptible GNB were independently associated with 30-day mortality. Mortality attributable to MDR-GNB was 43%. According to causative pathogens, attributable mortality was 33% in ESBL, 32% in KPC, 47% in MBL and 73% in CR-NFGNB.

CONCLUSIONS

In cancer patients, BSIs due to MDR-GNB are associated with excess mortality compared to BSI by susceptible GNB. Strategies to reduce the spread of MDR-GNB and to promote optimal management of affected patients are urgently needed.

摘要

目的

评估多重耐药（MDR）对革兰氏阴性杆菌（GNB）所致血流感染（BSI）癌症患者死亡率的影响。

患者与方法

这是一项前瞻性观察性多中心研究，纳入了由GNB引起BSI的癌症患者（2018年6月至2020年1月）。主要结局是30天死亡率。次要结局是由MDR微生物导致的死亡率，包括产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌、耐碳青霉烯类（CR）肠杆菌科细菌和CR非发酵GNB（CR-NFGNB）。多变量回归分析确定了与30天死亡率相关的因素。计算了调整后的优势比（aOR）及95%置信区间（95%CI）。根据DRIVE-AB联盟的公式估算归因死亡率。

结果

在347例癌症患者中，232例（66.9%）发生了由MDR-GNB引起的BSI。MDR微生物所致BSI患者的30天死亡率为27.2%，而敏感GNB所致BSI患者的死亡率为7%（<0.001）。在多变量分析中，与敏感GNB相比，包括产ESBL肠杆菌科细菌（aOR 8.734, 95%CI 1.411 - 54.077, = 0.02）、产KPC肠杆菌科细菌（aOR 8.548, 95%CI 1.296 - 56.411, = 0.026）、产金属β-内酰胺酶（MBL）肠杆菌科细菌（aOR 15.802, 95%CI 1.408 - 68.667, = 0.022）和CR-NFGNB（aOR 53.373, 95%CI 5.104 - 89.146, <0.001）在内的MDR-GNB与30天死亡率独立相关。MDR-GNB导致的死亡率为43%。根据致病病原体，ESBL导致的归因死亡率为33%，KPC为32%，MBL为47%，CR-NFGNB为73%。