Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?
Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?
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造血干细胞移植患者碳青霉烯类耐药肠杆菌的不同筛查频率：哪一种更好？
DOI：
10.1186/s13756-020-0706-0
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发表时间：
2020-02
影响因子：
5.5
通讯作者：
Jimin Shi
中科院分区：
文献类型：
--
作者：
Ting-Ting Yang;Xue-Ping Luo;Qing Yang;Hong-Chao Chen;Yi Luo;Yanmin Zhao;Yishan Ye;Xiaoyu Lai;Jian Yu;Yamin Tan;Guoqing Wei;He Huang;Jimin Shi
摘要背景对免疫抑制个体进行耐碳青霉烯类肠杆菌科细菌(CRE)的筛查可以降低CRE血流感染(BSI)的发生率，这一点已达成共识。方法回顾分析2017年9月至2019年4月收治的395例HSCT患者的临床资料。从2017年9月至2018年6月(第1期)，200名患者在移植前接受了单一CRE筛查。自2018年7月至2019年4月(第2期)，195名患者入院后每周连续接受CRE筛查。对于CRE定植的患者，接受有针对性的治疗：(1)接触预防措施和(2)如有必要，先发制人的CRE靶向治疗。结果1期共检出CRE定植3例(1.5%)。CRE BSI发生率为2.0%(4例)，30d死亡率为50.0%(2/4例)。第2期共检出Cre定植21例，检出率明显高于第1期(P<；0.001)。在21名定居患者中，4名(19.0%)患者在第一次筛查中被确认为Cre阳性，5名(23.8%)在第二次筛查中被确认，其余12名(57.1%)在第三次或以后的筛查中被确认。CRE BSI发生率降至0.5%(1/195)，无CRE相关死亡。15名殖民地患者出现中性粒细胞减少性发热。13名移居者在发热后24小时内接受了替加环素的预防性治疗，并实现了快速体温控制。一名移居者在发烧后48小时后接受了替格环素治疗，由于添加了多粘菌素，最终存活了下来。另1例在发热后72小时内接受替加环素治疗，死于感染性休克。结论筛查频率的提高有助于CRE定植患者的发现。对这些定植的患者进行针对性的治疗可能有助于降低CRE BSI的发生率和死亡率，从而改善患者的预后。
Abstract Background A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). Methods We retrospectively studied the clinical data of 395 consecutive HSCT patients from September 2017 to April 2019. From September 2017 to June 2018 (period 1), 200 patients received single CRE screening before transplantation. From July 2018 to April 2019 (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. Results During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 ( P < 0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 h of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 h after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 h after fever onset and died of septic shock. Conclusion The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.
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影响因子：
5.3
作者：
通讯作者：
--
DOI：
10.1016/j.ijantimicag.2016.01.011
发表时间：
2016-04-01
影响因子：
10.8
作者：
Tofas, Polydoros;Skiada, Anna;Daikos, George L.
通讯作者：
Daikos, George L.
影响因子：
20.3
作者：
S. Jaiswal;Satyanker Gupta;Amit Sherawat;S. Vinod;H. Jacob;Sajin V Abraham;A. Chaturvedi;S. Chakrabarti
通讯作者：
S. Jaiswal;Satyanker Gupta;Amit Sherawat;S. Vinod;H. Jacob;Sajin V Abraham;A. Chaturvedi;S. Chakrabarti
影响因子：
11.8
作者：
Satlin, Michael J.;Jenkins, Stephen G.;Walsh, Thomas J.
通讯作者：
Walsh, Thomas J.
影响因子：
4.9
作者：
Anong Kiddee;Kanit Assawatheptawee;Anamai Na-udom;P. Treebupachatsakul;Apirath Wangteeraprasert;T. Walsh;P. Niumsup
通讯作者：
Anong Kiddee;Kanit Assawatheptawee;Anamai Na-udom;P. Treebupachatsakul;Apirath Wangteeraprasert;T. Walsh;P. Niumsup