Inappropriate initial antimicrobial therapy for hematological malignancies patients with Gram-negative bloodstream infections
Inappropriate initial antimicrobial therapy for hematological malignancies patients with Gram-negative bloodstream infections
复制标题
革兰氏阴性血流感染的血液恶性肿瘤患者初始抗菌治疗不当
DOI：
10.1007/s15010-019-01370-x
复制
发表时间：
2020-02-01
期刊：
影响因子：
7.5
通讯作者：
Li, Xin
中科院分区：
文献类型：
--
作者：
Tang, Yishu;Wu, Xinyu;Li, Xin
不适当的初始抗菌治疗（IIAT）可能会增加血液恶性肿瘤（HM）患者的革兰阴性菌血流感染（GN-BSI）的死亡率。本研究的目的是确定是否IIAT影响预后，在这个病人群体，并建议适当的抗生素方案，以尽量减少IIAT。方法我们回顾了一项回顾性队列研究的361例HM患者从GN-BSI的贫血热。结果GN-BSI致HM贫血发热患者的IIAT阳性率为21.3%。抗生素治疗组与IIAT治疗组的7天死亡率有显著性差异（7.7% vs29.9%，P < 0.01）。多因素分析证实IIAT是早期死亡的独立危险因素[4.860（1.541-15.323）]。革兰阴性菌药敏数据提示，碳青霉烯类单药或β-内酰胺酶抑制剂（BLBLI）联合阿米卡星作为初始治疗可有效降低IIAT发生率。在基于既往抗生素暴露的分层免疫图中，我们的结果表明BLBLI单药治疗最初可用作既往无抗生素暴露患者的经验性治疗。结论IIAT是导致GN BSI伴血小板减少性发热HM患者死亡的重要因素。
Background Inappropriate initial antimicrobial therapy (IIAT) may increase the mortality rate of hematological malignancies (HMs) patients with Gram-negative bacteria bloodstream infections (GN-BSI). The aim of this study is to determine whether IIAT affects the prognosis in this patient population and recommend the appropriate antibiotic regimen to minimize IIAT.Methods We reviewed a retrospective cohort study of 361 HM patients with neutropenic fever from GN-BSI. The patients' clinical characteristics and the results of the drug sensitivity test in vitro were analyzed.Results IIAT rate was 21.3% in HM patients with neutropenic fever caused by GN-BSI. There was a significant difference in 7-day mortality rate between patients treated with appropriate antibiotics and those with IIAT (7.7% vs 29.9%, p < 0.01). Multivariate analysis confirmed that IIAT was an independent risk factors for early mortality [4.860 (1.541-15.323)]. Drug sensitivity data of GN-bacteria suggested that carbapenems monotherapy or beta-lactamase inhibitors (BLBLI) combined with amikacin as the initial therapy can effectively reduce the IIAT rate. In the stratified antibiogram based on prior antimicrobial exposure, our results showed that BLBLI monotherapy could be initially used as an empirical treatment in patients without prior antimicrobial exposure. In those who had received prior antimicrobial exposure, BLBLI (especially piperacillin-tazobactam) combined with amikacin is recommended.Conclusions IIAT was a critical factor contributing to the mortality of HM patients with neutropenic fever from GN-BSI.