Gut Colonization with Carbapenem Resistant Enterobactriaceae (CRE) Adversely Impacts the Outcome in Patients with Hematological Malignancies: Results of a Prospective Surveillance Study
Gut Colonization with Carbapenem Resistant Enterobactriaceae (CRE) Adversely Impacts the Outcome in Patients with Hematological Malignancies: Results of a Prospective Surveillance Study
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DOI：
10.1182/blood.v128.22.2402.2402
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发表时间：
2016-12
期刊：
影响因子：
20.3
通讯作者：
S. Jaiswal;Satyanker Gupta;Amit Sherawat;S. Vinod;H. Jacob;Sajin V Abraham;A. Chaturvedi;S. Chakrabarti
中科院分区：
文献类型：
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作者：
S. Jaiswal;Satyanker Gupta;Amit Sherawat;S. Vinod;H. Jacob;Sajin V Abraham;A. Chaturvedi;S. Chakrabarti
CRE是患有血液恶性肿瘤的患者的主要关注点，但关于此类患者中定植影响的数据很少。我们对2013年10月至2016年1月期间需要住院的225例血液恶性肿瘤（HM）患者进行了CRE前瞻性监测研究。队列的中位年龄为45岁（范围，2-84岁）。该队列包括广泛代表性疾病; AML（n=58）、ALL（n=44）、淋巴瘤（n=76）、骨髓瘤（n=22）、CML（8）和其他（n=17）。所有患者在入院第一天进行直肠拭子培养，随后每周重复一次，以连续住院或随后入院。47例（21%）患者入院时定植CRE。在延长住院时间/接触超过4周时，这一比例增加至45%，共有72例（32%）患者被定植。在诊断时CRE定殖的最高数量的患者是AML患者（30%）。6个月时队列的非复发死亡率（NRM）为10.3%。这在急性白血病患者中为14%，而在其他患者中为5.8%（p=0.02）。此外，这在AML患者中最高（22.9% vs其他患者6.1%; p=0.001）。CRE相关事件占死亡率的77%。住院期间CRE定植者的NRM为29.6%，而入院时CRE定植者的NRM为10.5%，未定植者的NRM为10.5%（p=0.0001）。在AML患者中，住院期间CRE定植与NRM的相关性为54.9%（95%CI 32.4-67.4%），而入院时定植者（11.8; 95%CI 4.0-19.6）和未定植者（0%）的相关性为54.9%（95%CI 32.4-67.4%）（p=0.0001）。这种趋势在无AML的患者中也是如此（27.3% vs 10.3% vs 0%; p=0.0001）。多因素分析显示，住院期间CRE定植是恶性血液病患者发生NRM的最重要危险因素（HR-7.1; 95%CI 3.1-16.1）。我们的数据表明，相当大比例的HM患者在没有住院治疗的情况下被CRE定殖，但那些医院定殖的患者死亡风险最高，特别是AML患者。没有相关的利益冲突需要申报。
CRE is the major concern in the patients suffering from hematological malignancy but the data on the impact of colonization in such patients is scarce. We conducted a prospective surveillance study of CRE on 225 patients of haematological malignancies (HM), who required hospital admission between October 2013 to January 2016. The median age of the cohort was 45 years(range,2-84). The cohort included a broad representation of diseases; AML (n=58), ALL(n=44), Lymphoma (n=76), Myeloma(n=22), CML(8) and Others (n=17). Rectal swabs were taken for cultures in all patients during first day of admission and repeated subsequently on weekly basis for continuous hospital stay or in subsequent admissions.47 (21%) patients were colonized with CRE on admission. This increased to 45% on prolonged hospital stay/ contact for more than 4 weeks with 72 (32%) patients being colonized overall. The highest number of patients colonized with CRE at diagnosis was those with AML (30%). The non-relapse mortality (NRM) of the cohort at 6 months was 10.3%. This was 14% in those with acute leukemia compared to 5.8% in others (p=0.02). Furthermore, this was highest in patients with AML (22.9% vs 6.1% in others; p=0.001). CRE related events accounted for 77% of mortality. NRM was 29.6% in those colonized with CRE during hospitalization compared to 10.5% in those colonized at admission with no NRM in those not colonized with CRE (p=0.0001). Amongst patients with AML, colonization with CRE during hospitalization was associated with a NRM of 54.9%(95%CI 32.4-67.4%) compared to those colonized at admission(11.8; 95%CI 4.0-19.6) and those not colonized(0%)(p=0.0001). This trend was true for patients without AML as well (27.3% vs 10.3% vs 0%; p=0.0001). On multivariate analysis, colonization with CRE during hospitalization was the most important risk factor for NRM in patients with hematological malignancies (HR-7.1; 95%CI 3.1-16.1). Our data demonstrates that a substantial proportion of patients with HM are colonized with CRE without prior hospitalisations but those with nosocomial colonization have the highest risk of mortality, particularly in those with AML. Disclosures No relevant conflicts of interest to declare.