摘要
目的 评估血液病患者血流感染耐碳青霉烯肠杆菌(CRE)的危险因素。方法 回顾性纳入肠杆菌科细菌菌血症的血液病患者112例,根据从血培养标本中分离出的肠杆菌科细菌对碳青霉烯类药物的敏感性,将所有患者分为CRE组(26例)及碳青霉烯敏感肠杆菌组(CSE组,86例)。收集所有患者的临床资料,包括性别、年龄、住院时间、既往住院次数、原发病、接受标准治疗后的状态、带有经外周静脉穿刺中心静脉置管(PICC)、粒细胞缺乏时间、确诊前多器官系统症状、治疗方法、3个月内抗生素使用情况、原发病、肠杆菌种类、生存结局并分组进行比较。相关性分析采用单因素及多因素logistic回归分析。结果 CRE组住院时间、粒细胞缺乏时间、院内感染、死亡、确诊前出现消化系统症状、接受嵌合抗原受体T细胞(CAR-T)治疗、3个月内使用第三代头孢菌素及碳青霉烯类抗生素患者比例均高于CSE组,原发病接受标准治疗后缓解患者比例低于CSE组(P<0.05)。CRE组感染肺炎克雷伯菌患者比例高于CSE组,感染大肠埃希菌患者比例低于CSE组(P<0.001)。CRE组患者的中位生存期仅为3.5天,CSE组患者的中位生存期未达。单因素logistic回归分析结果显示,原发病接受标准治疗后缓解状态、粒细胞缺乏时间、确诊前出现消化系统症状,接受CAR-T治疗、住院时间、3个月内使用第三代头孢菌素和碳青霉烯类抗生素均与血液病患者发生CRE菌血症相关(P<0.05)。多因素logistic回归分析结果显示,粒细胞缺乏时间、确诊前出现消化系统症状、3个月内使用第三代头孢菌素和碳青霉烯类抗生素均为血液病患者发生CRE菌血症的独立危险因素(P<0.05)。结论 粒细胞缺乏时间、确诊前出现消化系统症状、3个月内使用第三代头孢菌素和碳青霉烯类抗生素均为血液病患者血流感染CRE的独立危险因素,临床医师应早期识别感染高�
Objective To evaluate the risk factors of bloodstream infection with carbapenem⁃resistant enterobacter(CRE)in patients with hematologic diseases.Methods A total of 112 patients with hematologic diseases of enterobacteriaceae bacteremia were retrospectively included.According to the sensitivity of enterobacteriaceae bacteria isolated from blood culture samples to carbapenems,all patients were divided into CRE group(26 cases)and carbapenem sensitive enterobacteriaceae(CSE)group(86 cases).Clinical data of all patients were collected,included gender,age,length of stay,number of previous hospitalizations,primary disease,status after standard treatment,with peripherally inserted central catheter(PICC),neutropenia time,multiple organ systern symptoms before diagnosis,treatment method antibiotic use within 3 months,protopathy,enterobacter type,survival outcome and compared in groups.Correlation analysis was performed by univariate and multifactorial logistic regression analysis.Results Hospitalization days,the proportion of patients with neutropenia time,nosocomial infection,death,digestive symptoms before diagnosis,CAR⁃T therapy,third⁃generation cephalosporin and carbapenems antibiotics used within 3 months in CRE group were higher than those in CSE group,and the proportion of patients with remission after primary disease standard treatment was lower than that in CSE group(P<0.05).The proportion of patients infected with Klebsiella pneumoniae in CRE group was higher than that in CSE group,and the proportion of patients infected with escherichia coli was lower than that in CSE group(P<0.001).The median survival in the CRE group was only 3.5 days,while the median survival in the CSE group was not reached.Univariate logistic regression analysis showed that remission status after primary disease standard treatment,neutropenia time,digestive symptoms before diagnosis,CAR⁃T therapy,hospitalization days and use of third⁃generation cephalosporin and carbapenem antibiotics within 3 months were all associated with CRE b
作者
李赟
李琳
林漓
尹琎
徐金环
汪玥
陈中举
隗佳
孙自镛
张义成
Li Yun;Li Lin;Lin Li;Yin Jin;Xu Jinhuan;Wang Yue;Chen Zhongju;Wei Jia;Sun Ziyong;Zhang Yicheng(Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《临床内科杂志》
CAS
2023年第9期609-612,共4页
Journal of Clinical Internal Medicine
基金
国家自然科学基金面上项目(81873446)。
关键词
耐碳青霉烯肠杆菌
血液病
危险因素
血流感染
粒细胞缺乏
Carbapenem⁃resistant enterobacter
Hematological
Risk factors
Bloodstream infection
Neutropenia
