Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria
Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria
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DOI：
10.1007/s00277-018-3341-6
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发表时间：
2018-09-01
影响因子：
3.5
通讯作者：
Pagano, L.
中科院分区：
文献类型：
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作者：
Cattaneo, C.;Di Blasi, R.;Pagano, L.
多重耐药（MDR）细菌感染是血液病患者中令人担忧的现象。关于血液病患者MDR定植和相关血流感染（BSI）发生率的数据很少。计划在6个月期间在18个血液学机构进行一项多中心前瞻性观察性研究。记录所有显示MDR直肠定植以及入院时BSI发生的患者。观察到144例MDR定植患者（占2226例住院患者的6.5%）。在64/144例患者中观察到产超广谱β-内酰胺酶（ESBL）（ESBL-P）肠杆菌，85/144例患者中观察到碳青霉烯类耐药（CR）革兰氏阴性菌，9/144例患者中观察到万古霉素耐药肠球菌（VRE）。总体而言，37例MDR定植患者（25.7%）至少发生了一次BSI;其中23例（62.2%，占整个系列的16%）由同一病原体（MDRrel BSI）发生BSI，ESBL-P肠杆菌发生率为15.6%（10/64），CR革兰阴性菌为14.1%（12/85），VRE为11.1%（1/9）。在20/23例病例中，MDRrel BSI发生在中性粒细胞减少期间。中位随访80天后，18例患者死亡（12.5%）。CR革兰阴性菌（83.6%）和VRE（77.8%）患者的3个月总生存率显著低于ESBL-P肠杆菌（96.8%）。CR-rel BSI和导尿管的存在是死亡率的独立预测因素。MDR直肠定植发生在6.5%的血液科住院患者中，并预测MDRrel BSI的概率为16%，特别是在中性粒细胞减少期间，以及CR-rel BSI中不良结局的概率更高。应根据定植情况决定是否采用经验性抗生素治疗。
Infections by multidrug-resistant (MDR) bacteria are a worrisome phenomenon in hematological patients. Data on the incidence of MDR colonization and related bloodstream infections (BSIs) in haematological patients are scarce. A multicentric prospective observational study was planned in 18 haematological institutions during a 6-month period. All patients showing MDR rectal colonization as well as occurrence of BSI at admission were recorded. One-hundred forty-four patients with MDR colonization were observed (6.5% of 2226 admissions). Extended spectrum beta-lactamase (ESBL)-producing (ESBL-P) enterobacteria were observed in 64/144 patients, carbapenem-resistant (CR) Gram-negative bacteria in 85/144 and vancomycin-resistant enterococci (VREs) in 9/144. Overall, 37 MDR-colonized patients (25.7%) developed at least one BSI; 23 of them (62.2%, 16% of the whole series) developed BSI by the same pathogen (MDRrel BSI), with a rate of 15.6% (10/64) for ESBL-P enterobacteria, 14.1% (12/85) for CR Gram-negative bacteria and 11.1% (1/9) for VRE. In 20/23 cases, MDRrel BSI occurred during neutropenia. After a median follow-up of 80 days, 18 patients died (12.5%). The 3-month overall survival was significantly lower for patients colonized with CR Gram-negative bacteria (83.6%) and VRE (77.8%) in comparison with those colonized with ESBL-P enterobacteria (96.8%). CR-rel BSI and the presence of a urinary catheter were independent predictors of mortality. MDR rectal colonization occurs in 6.5% of haematological inpatients and predicts a 16% probability of MDRrel BSI, particularly during neutropenia, as well as a higher probability of unfavourable outcomes in CR-rel BSIs. Tailored empiric antibiotic treatment should be decided on the basis of colonization.