Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies.
Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies.
复制标题
血液系统恶性肿瘤患者耐碳青霉烯类肺炎克雷伯菌血流感染的临床特征及危险因素
DOI：
10.2147/idr.s272217
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发表时间：
2020
影响因子：
3.9
通讯作者：
Qu T
中科院分区：
文献类型：
--
作者：
Zhang P;Wang J;Hu H;Zhang S;Wei J;Yang Q;Qu T
目的是研究血液恶性肿瘤患者中碳青霉烯类耐药肺炎克雷伯菌（CRKP）所致血流感染（BSI）的临床特征和危险因素。进行了一项单中心、回顾性病例对照研究，代表了2017年1月1日至2018年12月31日期间734例血液恶性肿瘤患者。从医院电子病历系统中收集人口统计学和临床数据。在734例恶性血液病患者中，3%（22/734）的患者在住院期间发生CRKP BSI。总体28天全因死亡率达到77.3%（17/22）。Pitt菌血症评分（PBS）>4、肺炎和感染性休克的患者在非幸存者中比幸存者更常见。与非存活者相比，存活者更常使用替加环素和多粘菌素B联合治疗。与CRKP BSI相关的独立风险因素为CRKP直肠定植（OR，11.067; CI=4.43-27.644; P<0.001; 3分），重度中性粒细胞减少（OR，4.095; CI=0.876-19.141; P=0.073; 1分）和BSI发作前30天内的有创机械通气（IMV）（OR，18.444; CI=1.787-190.343; P=0.014; 4分）。总风险评分≥5表明CRKP BSI发生概率大于48%。恶性血液病患者的CRKP BSI与高死亡率相关。基于风险因素的预测模型可能有助于临床医生对疑似CRKP BSI的患者进行及时有效的抗感染治疗并改善结局。
The aim was to examine the clinical characteristics and risk factors for bloodstream infection (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients with hematologic malignancies. A single-centre, retrospective case–control study representing 734 patients with hematologic malignancies between January 1, 2017, and December 31, 2018, was conducted. Demographic and clinical data were collected from the hospital electronic medical records system. Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt bacteremia score (PBS) >4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors. Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR, 11.067; CI=4.43–27.644; P<0.001; 3 points), severe neutropenia (OR, 4.095; CI=0.876–19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR, 18.444; CI=1.787–190.343; P=0.014; 4 points). The total risk score of ≥5 indicated that the probability of CRKP BSI occurrence was above 48%. CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor-based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes.