Objective: To analyze the pathogenic bacterial spectrum, drug resistance, and risk factors associated with multidrug-resistant bacterial infection and mortality in patients with hematologic diseases complicated by bloodstream infections, so as to provide reference for rational drug use and improving prognosis.
Methods: Positive blood culture specimens of patients with hematologic diseases in two Class A tertiary hospitals of Shanxi province from January 2019 to December 2021 were retrospectively analyzed. Pathogen distribution, drug resistance and outcomes of patients with bloodstream infection were investigated, then the multivariate logistic analysis was performed to analyze the risk factors of multidrug-resistant bacterial infection and factors affecting prognosis.
Results: 203 strains of pathogens were identified, mainly Gram-negative bacteria (GNB) (69.46%, 141/203), of which Escherichia coli (E.coli) had the highest incidence (41.13%, 58/141), followed by Klebsiella pneumoniae (20.57%, 29/141) and Pseudomonas aeruginosa (12.77%, 18/141). Extended-spectrum beta-lactamase (ESBL)-producing E.coli and Klebsiella pneumoniae were 46.55% (27/58) and 37.93% (11/29), respectively. Carbapenem-resistant Gram-negative bacteria accounted for 10.64% (15/141). And Gram-positive bacteria accounted for 27.59% (56/203), Staphylococcus epidermidis, Streptococcus pneumoniae, and Staphylococcus aureus were the most frequently isolated pathogen among Gram-positive bacteria (14.29%, 12.50% and 10.71%, respectively), of which methicillin-resistant Staphylococcus aureus accounted for 33.33% (2/6), coagulase-negative staphylococci accounted for 87.50% (7/8), without vancomycin- or linezolid-resistant strain. Additionally, fungi accounted for 2.95% (6/203), all of which were Candida. Multidrug-resistant Gram-negative bacteria (MDR-GNB) accounted for 53.90% (76/141). Duration of neutropenia >14 days was a risk factor for developing MDR-GNB infection. The 30-day all-cause mortality was 10.84%. Multivariate logistic regression analysis showed that the significant independent risk factors for mortality were age≥60 years (P <0.01, OR =5.85, 95% CI: 1.80-19.07) and use of vasopressor drugs (P <0.01, OR =5.89, 95% CI: 1.83-18.94).
Conclusion: The pathogenic bacteria of bloodstream infection in patients with hematological diseases are widely distributed, and the detection rate of multidrug-resistant bacteria is high. The clinicians should choose suitable antibiotics according to the results of bacterial culture and antibiotic susceptibility test.
题目: 血液病患者并发血流感染的病原菌分布、耐药性和死亡危险因素分析.
目的: 分析血液病患者并发血流感染的病原菌分布、耐药性及预后，为合理性用药及改善预后提供参考。.
方法: 回顾性分析2019年1月至2021年12月山西省两家三甲医院血液科血流感染阳性标本的病原菌分布、耐药性及结局，采用Logistic多因素回归分析导致多重耐药菌感染的危险因素及影响患者结局的预后因素。.
结果: 共分离出203株血培养阳性菌株，其中革兰阴性菌（GNB）141株（69.46%），主要为大肠埃希菌58株（41.13%）、肺炎克雷伯菌29株（20.57%）和铜绿假单胞菌18株（12.77%）；产生超广谱β-内酰胺酶（ESBL）菌的大肠埃希菌占46.55%（27/58），产ESBL的肺炎克雷伯菌占37.93%（11/29），碳青霉烯类耐药革兰阴性菌占10.64%（15/141）。革兰阳性菌56株（27.59%），主要为表皮葡萄球菌8株（14.29%）、肺炎链球菌7株（12.50%）与金黄色葡萄球菌6株（10.71%），其中耐甲氧西林金黄色葡萄球菌株占33.33%（2/6），耐凝固酶阴性葡萄球菌株占87.50%（7/8）。真菌6株（2.95%），均为念珠菌。多重耐药的革兰阴性菌（MDR-GNB）株占53.90% （76/141）。粒细胞缺乏>14 d是发生MDR-GNB感染的危险因素。30 d内全因死亡率为10.84%。Logistic多因素回归分析结果显示，年龄≥60岁（P <0.01，OR =5.85，95% CI：1.80-19.07）和使用血管升压药物 （P <0.01，OR =5.89，95% CI：1.83-18.94）为患者30 d内死亡的独立危险因素。.
结论: 血液病患者血流感染病原菌分布广 泛，多重耐药菌检出率高，应根据不同中心血流感染病原菌分布及耐药情况合理使用抗菌药物。.
Keywords: pathogenic bacteria; bloodstream infection; drug-resistance; mortality.