Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases
Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases
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DOI：
10.1016/j.ijantimicag.2016.01.011
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发表时间：
2016-04-01
影响因子：
10.8
通讯作者：
Daikos, George L.
中科院分区：
文献类型：
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作者：
Tofas, Polydoros;Skiada, Anna;Daikos, George L.
产碳青霉烯酶肺炎克雷伯菌（CP-Kp）是目前许多地理区域最重要的医院病原体之一。在2010年至2014年期间，在位于高患病率地区（希腊雅典）的四家医院进行了一项回顾性研究，以描述患有血液系统疾病并发CP-Kp血流感染的血小板减少症患者的临床特征、治疗和结局。共确定了50例患者，包括48例血液恶性肿瘤和2例再生障碍性贫血。所有患者均有中性粒细胞减少（< 500个细胞/mm（3）），其中40例中性粒细胞< 100个/mm（3）。在9名患者中确定了菌血症的可能来源;在其余41名患者中，菌血症被认为是原发性的。对于确定性治疗，30例患者接受联合治疗（两种或多种活性药物），10例接受单药治疗（一种活性药物），4例接受无活性药物治疗;其余6例患者在菌血症发作后48小时内死亡。14天全因死亡率分别为50%，38%和33%的人接受了一个，两个或三个活性药物。在考克斯比例风险模型中，未消退的中性粒细胞减少[风险比（HR）= 19.28，95%置信区间（CI）2.31-160.69; P = 0.006]、脓毒性休克（HR = 3.04，95%CI 1.06-8.78; P = 0.04）和一种活性药物治疗（单药治疗与联合治疗的HR = 3.95，95% CI 1.23-12.65; P = 0.02）是死亡的独立预测因素，而联合治疗与较低的死亡率相关。这些发现可能有助于医生对CP-Kp感染的血小板减少症患者做出治疗决定。(C)2016 Elsevier B. V.和国际化疗学会。All rights reserved.
Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (< 500 cells/mm(3)), of whom 40 had < 100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR) = 19.28, 95% confidence interval (CI) 2.31-160.69; P = 0.006], septic shock (HR = 3.04, 95% CI 1.06-8.78; P = 0.04) and treatment with one active drug (HR for monotherapy versus combination therapy = 3.95, 95% CI 1.23-12.65; P = 0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections. (C) 2016 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.