血液科碳青霉烯耐药革兰阴性菌感染的临床特征及预后危险因素分析 Translated title: Clinical characteristics and prognostic risk factors analysis of carbapenem-resistant organism in the department of hematology

Abstract

目的

了解血液科碳青霉烯耐药革兰阴性菌（CRO）感染的分布及耐药情况，分析影响CRO感染患者预后的危险因素，为临床CRO感染患者的治疗和预后判断提供依据。

方法

回顾性分析2018年1月至2020年6月血液科确诊的CRO感染患者181例，收集患者的临床和实验室检查等资料，分析影响患者30 d死亡的危险因素。在碳青霉烯类耐药肠杆菌科细菌（CRE）亚组中进一步评价CRE主动筛查的临床意义。

结果

分离出的181株CRO中CRE占47.2％，铜绿假单胞菌占37.0％，肺炎克雷伯菌占32.6％，对碳青霉烯类药物高度耐药，对亚胺培南耐药最低抑菌浓度（MIC）≥16 µg/ml的占76.8％（139/181）。菌株标本来源主要是血样和痰液。CRO和CRE感染患者30 d的全因死亡率分别为（41.4±3.7）％、（44.7±5.4）％。Cox多因素回归分析结果显示：降钙素原水平>0.2 ng/ml及亚胺培南耐药的MIC≥16 µg/ml是CRO感染30 d死亡的独立危险因素。CRE亚组分析结果显示，亚胺培南耐药的MIC≥16 µg/ml为CRE感染30 d死亡的独立危险因素。CRE主动筛查患者的30 d累积生存率高于未筛查患者［（68.0±9.3）％对（50.0±6.5）％， P＝0.21］。

结论

高亚胺培南耐药MIC值的致病菌严重影响血液科CRO感染患者预后，病死率高。开展CRE主动筛查有助于早期预防、早期诊断和早期治疗高危患者。

Translated abstract

Objective

To study the distribution and drug resistance of Carbapenem-Resistant Organism (CRO) and to analysis the risk factors of CRO 30-day mortality.

Methods

A total of 181 patients with CRO infection diagnosed in Department of Hematology, Fujian Medical University Union Hospital from January 2018 to June 2020 were retrospectively investigated. The clinical and laboratory data of the patients were collected, the prognosis of patients diagnosed with CRO infection in day 30 was followed up, and the risk factors of prognosis were analyzed. The clinical significance of Carbapenem-Resistant Enterobacteriaceae (CRE) active screening was further evaluated in the CRE subgroup.

Results

Among the total of 181 CRO isolates, 47.2％ were CRE, 37.0％ were Pseudomonas aeruginosa, and 32.6％ were Klebsiella pneumoniae, which were highly resistant to carbapenem and had high MIC value, 76.8％ (139/181) of CRO were MIC of imipenem resistance ≥16 µg/ml. The main sources of isolates were blood and sputum. The 30-day all-cause mortality rates of patients with CRO or CRE infection were (41.4±3.7)％ and (44.7±5.4)％, respectively. The COX multivariate regression analysis showed that the level of procalcitonin >0.2 ng/ml and the MIC value of imipenem resistance ≥ 16 µg/ml were independent risk factors for 30-day mortality of CRO infected patients. The CRE subgroup analysis showed that MIC value of imipenem resistance ≥16 µg/ml were independent risk factors for 30-day mortality of CRE infected patients. The 30-day cumulative survival rate of patients with CRE active screening was higher than the patients without CRE active screening [(68.0±9.3)％ vs (50.0±6.5)％, P＝0.21].

Conclusion

The high MIC value of imipenem resistance isolates seriously affects the prognosis of patients with CRO infection in the hematology department, and the mortality rate was high. CRE active screening is expected for early prevention, early diagnosis, and early treatment for high-risk patients.