血液病粒细胞缺乏患者合并产超广谱β内酰胺酶肠杆菌血流感染的临床特征分析

Analysis on clinical features of neutropenic patients with hematopathy accompanied by bloodstream infection due to extended-spectrum β-lactamases-producing Enterobacteriaceae

目的分析血液病粒细胞缺乏患者合并产超广谱β内酰胺酶(ESBLs)肠杆菌血流感染的临床特征。方法回顾性分析192例血液病粒细胞缺乏合并肠杆菌血流感染患者的临床资料。根据ESBLs检测结果,将患者分为产ESBLs组98例、非产ESBLs组94例。总结患者的病原体分布及耐药情况,比较两组血流感染后30 d内病死率,并分析血液病粒细胞缺乏患者合并产ESBLs肠杆菌血流感染的危险因素。结果192例患者中,检出大肠埃希菌114株,其中产ESBLs大肠埃希菌68株(59.6%);检出克雷伯菌属78株,其中产ESBLs克雷伯菌属30株(38.5%)。产ESBLs肠杆菌对哌拉西林他唑巴坦、美罗培南、亚胺培南、替加环素的耐药率均较低,分别为5.1%、2.9%、1.0%和0。多因素Logistic回归分析结果显示,1个月内第三代头孢菌素暴露是血液病粒细胞缺乏患者合并产ESBLs肠杆菌血流感染的危险因素(P<0.05)。结论血液病粒细胞缺乏患者合并产ESBLs肠杆菌血流感染时病死率高。第三代头孢菌素暴露会增加血液病粒细胞缺乏患者合并产ESBLs肠杆菌血流感染的风险,对于血液病粒细胞缺乏伴发热患者应尽早经验性使用可覆盖产ESBLs肠杆菌的抗菌素治疗。

Objective To analyze the clinical characteristics of neutropenic patients with hematopathy accompanied by bloodstream infection due to extended-spectrum β-lactamases(ESBLs)-producing Enterobacteriaceae.Methods The clinical data of 192 neutropenic patients with hematopathy accompanied bybloodstream infection due to Enterobacteriaceae were retrospectively analyzed.The patients were assigned to ESBLs-producing group(n=98)and ESBLs-non-producing group(n=94)according to the result of ESBLs detection.The distribution and drug resistance of pathogens were summarized,and the fatality rate within 30 days after bloodstream infection were compared between the two group;in addition,the risk factors for neutropenic patients with hematopathy accompanied by bloodstream infection due to ESBLs-producing Enterobacteriaceae were analyzed.Results In 192 patients,Escherichia coli was found in 114 cases,of which 68 cases(59.6%)were ESBLs-producing Escherichia coli;Klebsiella was found in78 cases,of which 30 cases(38.5%)were ESBLs-producing Klebsiella.ESBLs-producing Enterobacteriaceae had relatively lower resistance rates to piperacillin-tazobactam,meropenem,imipenem and tigecycline(5.1%,2.9%,1.0%and 0,respectively).Multivariate Logistic regression analysis revealed that exposure to third-generation cephalosporins within one month was the risk factor for developing bloodstream infection due to ESBLs-producing Enterobacteriaceae in the neutropenic patients with hematopathy(P<0.05).Conclusion A higher fatality rate is observed in neutropenic patients complicated with bloodstream infection due to ESBLs-producing Enterobacteriaceae.Exposure to third-generation cephalosporins might increase the risk of developing bloodstream infection due to ESBLs-producing Enterobacteriaceae in neutropenic patients with hematopathy,therefore,early and empirical antibiotic therapy should be employed to cover ESBLs-producing Enterobacteriaceae for neutropenia patients complicated with fever.