Epidemiology of Rapidly Growing Mycobacteria Bloodstream Infections
Epidemiology of Rapidly Growing Mycobacteria Bloodstream Infections
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DOI：
10.1016/j.amjms.2015.12.012
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发表时间：
2016-03-01
影响因子：
3.1
通讯作者：
Salgado, Cassandra D.
中科院分区：
文献类型：
--
作者：
Rodriguez-Coste, Michelle A.;Chirca, Ioana;Salgado, Cassandra D.
背景：快速生长分枝杆菌（RGM）血流感染（BSI）是一个新出现的问题，往往与治疗的挑战。我们审查的流行病学，治疗和结果超过5年期间的异质组提出我们的机构与RGM BSI.Materials和方法：一个回顾性队列研究的患者与原发性RGM BSI从2006年1月至2011年12月进行。记录患者特征（年龄、种族、性别和合并症）、感染特征（导管相关性、医院获得性、微生物学和抗菌药物敏感性）、治疗和结局，并按种属进行比较。患者平均有3-4种合并症，最常见的是恶性肿瘤（45.5%）。以偶发分枝杆菌或粘液分枝杆菌（27.2%）为主（30.3%），其次为龟分枝杆菌（18.2%）和免疫原性分枝杆菌（12.2%）。总的来说，85%是导管相关的，27.3%是医院获得的。19例（57.6%）患者开始经验性治疗，其中12例（63.2%）患者的经验性治疗充分（根据耐受性至少使用2种活性药物）。在21例有结局数据的患者中，假设14例（66.7%）治愈。1例死亡归因于RGM BSI。接受充分经验性治疗的患者的治愈率高于未接受经验性治疗的患者（83.3%对42.9%）。在一般情况下，抗生素的敏感性是有利的克拉霉素，阿米卡星和imipenem.Conclusions跨物种：RGM BSI发生在人口与多种合并症，最常见的恶性肿瘤，大多数导管相关。在接受充分经验性治疗的患者中观察到较高的治愈率，并且基于敏感性数据，克拉霉素、阿米卡星和亚胺培南的广泛经验性方案预计是足够的。
Background: Rapidly growing mycobacteria (RGM) bloodstream infections (BSI) are an emerging problem often associated with therapeutic challenges. We review the epidemiology, treatment and outcomes over a 5-year period of a heterogeneous group presenting to our institution with RGM BSI.Materials and Methods: A retrospective cohort study of patients with primary RGM BSI from January 2006-December 2011 was conducted. Patient characteristics (age, race, sex and comorbidities), infection characteristics (catheter associated, hospital acquired, microbiology and antimicrobial susceptibilities), therapy and outcomes were recorded and compared by species.Results: Among 32 patients, 33 RGM BSI occurred. Patients had an average of 3-4 comorbidities, most commonly malignancy (45.5%). Most isolates (30.3%) were Mycobacterium fortuitum or Mycobacterium mucogenicum (27.2%), followed by Mycobacterium abscessus/chelonae (18.2%) and Mycobacterium immunogenum (12.2%). In all, 85% were catheter associated and 27.3% were hospital acquired. Empiric therapy was started in 19 (57.6%) patients and among these, it was adequate (at least 2 active agents based on susceptibilities) in 12 (63.2%). Among 21 patients with outcome data, cure was assumed for 14 (66.7%). One death was attributable to RGM BSI. Cure rates were higher among those who received adequate empiric therapy compared to those who did not (83.3% versus 42.9%). In general, antibiotic susceptibility was favorable across species for clarithromycin, amikacin and imipenem.Conclusions: RGM BSI occurred in a population with multiple comorbidities, most commonly malignancy, and most were catheter associated. Higher cures were seen among those who received adequate empiric therapy and based on susceptibility data, a broad empiric regimen of clarithromycin, amikacin and imipenem would be expected to be adequate.