Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies - The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study.
Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies - The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study.
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血液系统恶性肿瘤患者的革兰氏阴性菌血流感染 - 病原体类型和抗生素耐药性模式的影响：一项回顾性队列研究
DOI：
10.2147/idr.s322812
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发表时间：
2021
影响因子：
3.9
通讯作者：
Li X
中科院分区：
文献类型：
--
作者：
Tang Y;Xu C;Xiao H;Wang L;Cheng Q;Li X
肠杆菌科（EB）和非发酵细菌（NFB）是血液学恶性肿瘤（HMs）患者革兰氏阴性血流感染（GN-BSI）的主要病原体。这两种病原体对抗生素具有不同的耐药机制。然而，病原体种类和抗生素耐药模式对HMs患者预后的影响尚不清楚。我们回顾性收集了2010年1月至2018年5月期间中国湖南省三家综合性医院的HMs患者的临床资料。数据分析了不同种类和模式的抗生素耐药对HMs患者预后的影响。从HMs和gn - bsi患者中分离的835株单菌以肠杆菌科（75.7%）居多。虽然bsi中MDR病原菌的检出率整体呈下降趋势，但亚分析显示bsi中扩展谱β-内酰胺酶产生（ESBL）肠杆菌科和碳青霉烯耐药病原菌的检出率呈上升趋势。不同菌种间比较，NFB感染相关的早期死亡率显著高于肠杆菌科（22.6% vs 9.7%, p < 0.001）。在不同的多药耐药（MDR）模式中，ESBL细菌对健康结果没有显著影响。另一方面，碳青霉烯耐药菌显著影响早期死亡率，如碳青霉烯耐药肺炎克雷伯菌（36.0% vs 7.6%, P < 0.001）和碳青霉烯耐药非发酵菌（44.7% vs 16.5%, P < 0.001）。我们的研究结果表明，抗生素耐药性的种类和模式都可以影响BSI期间HMs患者的早期死亡率。
Enterobacteriaceae (EB) and non-fermentative bacteria (NFB) are the main pathogens responsible for gram-negative bloodstream infections (GN-BSI) in patients with hematological malignancies (HMs). These two pathogen types have heterogeneous resistance mechanisms to antibiotics. However, the impact of pathogen species and pattern of antibiotic resistance on the outcomes of patients with HMs remains unclear. We retrospectively collected clinical data of patients with HMs at three comprehensive hospitals in Hunan Province, China, between January 2010 and May 2018. The data analyzed the impact that different species and patterns of antibiotic resistance had on the outcome of patients with HMs. The majority of the 835 monomicrobial isolates collected from patients with HMs and GN-BSIs were Enterobacteriaceae (75.7%). While detections of MDR pathogens in BSIs as a whole are decreasing, sub-analysis shows that detections of extended spectrum β-lactamase-producing (ESBL) Enterobacteriaceae and carbapenem-resistant pathogens in BISs are rising. Comparing different species, the early mortality rate associated with infections caused by NFB was significantly higher than infections caused by Enterobacteriaceae (22.6% vs 9.7%, p < 0.001). Across different multidrug-resistant (MDR) patterns, ESBL bacteria did not have a significant impact on health outcomes. Carbapenem-resistant bacteria, on the other hand, were observed to significantly affect early mortality rate, such as carbapenem-resistant Klebsiella pneumoniae (36.0% vs 7.6%, P < 0.001) and carbapenem-resistant non-fermentative bacteria (44.7% vs 16.5%, P < 0.001). Our findings suggest that both species and patterns of antibiotic resistance can affect the early mortality of patients with HMs during BSI.