Clinical characteristics and outcomes of Pseudomonas aeruginosa bacteremia in febrile neutropenic children and adolescents with the impact of antibiotic resistance: a retrospective study
Clinical characteristics and outcomes of Pseudomonas aeruginosa bacteremia in febrile neutropenic children and adolescents with the impact of antibiotic resistance: a retrospective study
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DOI：
10.1186/s12879-017-2597-0
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发表时间：
2017-07-17
影响因子：
3.7
通讯作者：
Kang, Jin Han
中科院分区：
文献类型：
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作者：
Kim, Hyo Sup;Park, Bo Kyoung;Kang, Jin Han
背景：尽管引入具有抗铜绿假单胞菌作用的抗生素后，铜绿假单胞菌感染的比例有所下降，但在免疫功能低下的患者中，铜绿假单胞菌菌血症仍会导致较高的死亡率。本研究确定了铜绿假单胞菌菌血症的临床特征和转归，以及从中性粒细胞减少发热患者分离的菌株对抗生素的敏感性。方法：选择2011-2016年间确诊为铜绿假单胞菌菌血症的31例中性粒细胞减少发热儿童和青少年为研究对象。他们的医疗记录被回顾，以评估人口统计学和临床特征。同时测定了分离的铜绿假单胞菌对8种抗生素(抗假单胞菌青霉素、抗假单胞菌青霉素与β-内酰胺酶抑制剂联合用药、抗假单胞菌头孢菌素、单菌素、碳青霉烯类、氨基糖苷类、氟喹诺酮类、粘菌素)的敏感率。在调查的因素中，确定了死亡和感染多重耐药(MDR)菌株的危险因素。结果：共鉴定出36例铜绿假单胞菌菌血症。入选患者的平均年龄为9.5+/-5.4岁，其中26例(72.2%)发病于男孩。急性髓系白血病(41.7%)和急性淋巴细胞性白血病(33.3%)是最常见的潜在疾病。30d死亡率为38.9%，其中36.1%为耐多药株所致。与存活患者相比，死亡患者更容易发生耐多药菌株的穿透性感染(P=0.036)和菌血症(P=0.005)。与死亡患者相比，存活患者更有可能接受适当的经验性抗生素治疗(P=0.024)和抗假单胞菌β-内酰胺类药物和氨基糖苷类药物的联合治疗(P=0.039)。铜绿假单胞菌对哌拉西林/他唑巴坦、美罗培南、阿米卡星的敏感率分别为67.6%、72.2%、100%。结论：铜绿假单胞菌菌血症致死率维持在38.9%，其中1/3以上为多药耐药。在此背景下，扩大抗生素谱的经验性抗生素联合治疗可能是降低中性粒细胞减少发热患者铜绿假单胞菌菌血症死亡率的一种策略。
Background: Although the proportion of Pseudomonas aeruginosa infections has reduced after the introduction of antibiotics with anti-pseudomonal effects, P. aeruginosa bacteremia still causes high mortality in immunocompromised patients. This study determined the clinical characteristics and outcomes of P. aeruginosa bacteremia and the antibiotic susceptibilities of strains isolated from febrile neutropenic patients.Methods: Thirty-one febrile neutropenic children and adolescents with underlying hematologic/oncologic disorders diagnosed with P. aeruginosa bacteremia between 2011 and 2016 were enrolled in the study. Their medical records were retrospectively reviewed to evaluate the demographic and clinical characteristics. Antibiotic susceptibility rates of the isolated P. aeruginosa to eight antibiotic categories (anti-pseudomonal penicillin, anti-pseudomonal penicillin and beta-lactamase inhibitor combination, anti-pseudomonal cephalosporin, monobactam, carbapenem, aminoglycoside, fluoroquinolone, and colistin) were also determined. Among the investigated factors, risk factors for mortality and infections by a multidrug-resistance (MDR) strain were determined.Results: Thirty-six episodes of P. aeruginosa bacteremia were identified. The mean age of the enrolled patients was 9.5 +/- 5.4 years, and 26 (72.2%) episodes occurred in boys. Acute myeloid leukemia (41.7%) and acute lymphoblastic leukemia (33.3%) were the most common underlying disorders. The 30-day mortality was 38.9%, and 36.1% of the episodes were caused by MDR strains. The deceased patients were more likely to experience breakthrough infection (P = 0.036) and bacteremia (P = 0.005) due to MDR strains when compared with the patients who survived. The survived patients more likely received appropriate empirical antibiotic therapy (P = 0.024) and anti-pseudomonal beta-lactam and aminoglycoside combination therapy (P = 0.039) compared with the deceased patients. The antibiotic susceptibility rates of the isolated P. aeruginosa strains were as follows: piperacillin/tazobactam, 67.6%; meropenem, 72.2%; and amikacin, 100%.Conclusions: Mortality due to P. aeruginosa bacteremia remained at 38.9% in this study, and more than one-third of the isolated strains were MDR. In this context, empirical antibiotic combination therapy to expand the antibiotic spectrum may be a strategy to reduce mortality due to P. aeruginosa bacteremia in febrile neutropenic patients.