Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?
Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?
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DOI：
10.1038/sj.bmt.1705530
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发表时间：
2006-12-01
影响因子：
4.8
通讯作者：
Khoury, H. J.
中科院分区：
文献类型：
--
作者：
Dubberke, E. R.;Hollands, J. M.;Khoury, H. J.
血液系统恶性肿瘤患者和造血干细胞移植（HSCT）接受者因耐药微生物而面临细菌性血流感染（BSI）的高风险。描述该患者群体中耐万古霉素肠球菌 (VRE) BSI 结果的数据有限。我们对 1996 年 2 月至 2002 年 12 月期间 Barnes-Jewish 医院白血病/HSCT 病房发生的所有 VRE BSI 病例进行了回顾性队列研究。 60 名患有急性（53%）或慢性（8%）白血病、非霍奇金淋巴瘤（22%）或其他恶性血液疾病（17%）的患者中有 68 次 VRE BSI 发作。共有 13%、32% 和 32% 分别接受自体移植、相关移植和匹配非相关移植。 42 名同种异体移植受者患有活动性急性移植物抗宿主病 (GVHD)，32% 患有慢性 GVHD。仅 57% 患有中性粒细胞减少症，52% 患有难治性/复发性恶性肿瘤，60% 患有终末器官功能障碍，中位 APACHE II 评分为 17。VRE BSI 后中位生存期为 19 天。根据多变量分析，肺炎、接受抗真菌药物和 VRE BSI 时 APACHE II 评分低仍然是死亡的重要危险因素。我们的分析表明，在患有血液恶性肿瘤或 HSCT 的患者中，VRE 可能不具有剧毒病原体的行为。 VRE BSI 可能只是这些患者已经存在的危重医疗状况的一个标志。
Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial bloodstream infections (BSI) owing to resistant organisms. Data describing the outcomes of vancomycin-resistant enterococcal (VRE) BSI in this patient population are limited. We performed a retrospective cohort study of all cases of VRE BSI that occured between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. There were 68 episodes of VRE BSI in 60 patients with acute (53%) or chronic (8%) leukemia, non-Hodgkin's lymphoma (22%) or other malignant hematologic disorders (17%). A total of 13, 32 and 32% were recipients of autologous, related and matched-unrelated transplants, respectively. Forty-two of allograft recipients had active acute graft-versus-host disease (GVHD) and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy and 60% had end organ dysfunction with a median APACHE II score of 17. Median survival after VRE BSI was 19 days. Pneumonia, receipt of anti-fungal drugs and low APACHE II score at the time of the VRE BSI remained significant risk factors for death on multivariable analysis. Our analysis suggests that in patients with hematological malignancies or HSCT, VRE may not have the behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients' already existing critical medical condition.