Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia
Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia
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DOI：
10.1016/j.cmi.2015.12.010
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发表时间：
2016-04-01
影响因子：
14.2
通讯作者：
Abdala, E.
中科院分区：
文献类型：
--
作者：
Freire, M. P.;de Oliveira Garcia, D.;Abdala, E.
本研究旨在描述癌症患者中广泛耐药鲍曼不动杆菌-醋酸钙复合体（XDR-ABC）的严重感染，并调查死亡率的危险因素。这是一项回顾性研究，包括2009年7月至2013年7月期间在癌症医院重症监护室住院期间诊断为XDR-ABC菌血症的所有患者。在研究期间每周收集监测培养物，并使用脉冲场凝胶电泳（PFGE）分析克隆性。我们分析了基础疾病、肿瘤治疗、中性粒细胞计数、感染部位和感染管理与30天死亡率的相关性。在研究期间，确定了92例XDR-ABC菌血症患者，其中35例（38.0%）为血液系统恶性肿瘤患者。我们发现XDR-ABC菌株具有四种不同的谱型，91.3%的患者携带主要的PFGE型。在92例XDR-ABC菌血症患者中，66例（71.7%）发生中心静脉导管相关血流感染; 22例（23.9%）发生中性粒细胞减少症期间发生感染; 58例（63.0%）在接受适当治疗前死亡。所有患者均接受多粘菌素治疗，其中30例（32.4%）用于联合治疗。30天死亡率为83.7%。多变量分析显示，诊断为XDR-ABC感染时的感染性休克是30天死亡率的危险因素;保护因素是在最初48小时内接受适当治疗和侵入性器械取出。在癌症患者中，这种感染的无效管理增加了死亡的风险，比肿瘤部位的中性粒细胞减少和感染等特征更重要。(C)2015年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site. (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.