Blood Stream Infections in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Reemergence of Gram-Negative Rods and Increasing Antibiotic Resistance
Blood Stream Infections in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Reemergence of Gram-Negative Rods and Increasing Antibiotic Resistance
复制标题
DOI：
10.1016/j.bbmt.2008.10.024
复制
发表时间：
2009-01-01
影响因子：
4.3
通讯作者：
Viscoli, Claudio
中科院分区：
文献类型：
--
作者：
Mikulska, Malgorzato;Del Bono, Valerio;Viscoli, Claudio
血流感染（BSI）是造血干细胞移植（HSCT）患者发病和死亡的众所周知的原因。本研究旨在分析2004-2007年期间在一个中心接受同种异体HSCT的患者中BSI的病原学和微生物耐药性。在132名患者中有168次BSI发作（HSCT后中位数10天），分离出182种病原体。革兰阳性菌（GPB）占57%。革兰氏阴性杆菌（GNR）占37%，真菌占6%。所有患者均接受常规氟喹诺酮预防治疗。随着时间的推移，GPB/GNR比率大幅下降，从2004年的2.4降至2007年的1（P = 0.043）。在GPB中，葡萄球菌从2004-2005年的37/68（64%）下降到2006-2007年的8/35（23%）（P < .002）。粪肠球菌/E.屎肠球菌比率从2004年的4.5下降到2007年的0.33（P = 0.006），而每年肠球菌菌株的总数没有变化。GNR中大肠杆菌的发病率从2004年的3/15（20%）增加到2007年的13/21（62%）（P = .003）。氟喹诺酮类药物耐药是常见的，在GPB和GNR（分别为81%和74%）。BSI后7天的死亡率为11%（19/168），铜绿假单胞菌BSI达到39%（7/18）。BSI仍然是同种异体HSCT的常见且可能危及生命的并发症，其致病微生物影响7天和30天死亡率。BSI病因可能会迅速改变，需要实施新的药物治疗方案。
Blood stream infections (BSI) are a well-known cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) patients. The aim of this study was to analyze etiology and microbial resistance of BSI in patients undergoing allogeneic HSCT in a single center over a 4-year period (2004-2007). There were 168 episodes of BSI in 132 patients (median 10 days after HSCT) and 182 pathogens were isolated. Gram-positive bacteria (GPB) accounted for 57% of 182 isolates. Gram-negative rods (GNR) for 37% and fungi for 6%. All patients received routine fluoroquinolone prophylaxis. There was a significant decrease in GPB/GNR ratio over time, from 2.4 in 2004 to I in 2007 (P = .043). Among GPB, staphylococci decreased from 37 of 68 (64%) in 2004-2005 to 8 of 35 (23%) in 2006-2007 (P < .002). The Enterococcus faecalis/E. faecium ratio decreased from 4.5 in 2004 to 0.33 in 2007 (P = .006), whereas the total number of enterococcal strains per year did not change. The incidence of Escherichia coli among GNR increased from 3 of 15 (20%) in 2004 to 13 of 2 1 (62%) in 2007 (P = .003). Fluoroquinolone-resistance was common, both among GPB and GNR (81% and 74%, respectively). Mortality rate at 7 days after BSI was 11% (19 of 168), reaching 39% for Pseudomonas aeruginosa BSI (7 of 18). BSI remains a frequent and potentially life-threatening complication of allogeneic HSCT, the causative organism influencing 7- and 30-day mortality rate. BSI etiology may change rapidly, requiring implementation of new empirical-therapy schemes.