Objective: To assess the risk factors for mortality and clinical outcome of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections in patients with hematological disorders. Methods: The data of in-patients with hematological disorders infected by CRPA or carbapenem-susceptible Pseudomonas aeruginosa (CSPA) were recorded in a seven-year retrospective cohort study. Risk factors for CRPA infections and impact of on mortality were identified. The primary end point was 30-day all-cause mortality. Results: A total of 81 patients with PA infections were included in the study, including 58 CSPA and 23 CRPA. Most of the primary diseases were acute leukemia or lymphoma (79.0%, 64/81). The median absolute neutrophil count at infection onset was 0.24×10(9)/L. Independent risk factors associated with carbapenem-resistance included longer duration of hospital stay (P=0.013, OR=1.045) and carbapenem exposure one month prior to infections (P=0.005, OR=8.132). The 30-day all-cause mortality of the whole cohort was 29.6%(24/81), and 30-day attributable mortality was 13.6%(11/81). Pulmonary infection was the leading cause of death, accounting for 41.7%(10/24). The adjusted 30-day mortality rate was significantly higher in patients with CRPA compared with CSPA [60.9%(14/23) vs. 17.2%(10/58), P<0.001, respectively]. CRPA infection was an independent prognostic factor for 30-day mortality(P=0.011, OR=5.427). Other factors included old age, longer duration of neutropenia and poor functional performance. Conclusions: Patients with hematological disorders have high mortality rate and poor prognosis caused by CRPA infections, which mainly develop in lungs.
目的： 评估碳青霉烯类耐药铜绿假单胞菌（CRPA）对血液病患者病死率的影响，寻找引起感染的预测因素和分析预后的风险因素，为预防和治疗CRPA提供依据。 方法： 本项研究为回顾性队列研究。纳入上海市第一人民医院2010年1月至2016年12月血液系统疾病治疗期间住院的铜绿假单胞菌感染的成人患者。比较CRPA和碳青霉烯类敏感铜绿假单胞菌（CSPA）感染患者的临床特征、预后因素和病死率。主要观察终点是30 d全因病死率。 结果： 共81例患者纳入研究，CSPA组58例，CRPA组23例，主要为急性白血病和淋巴瘤患者，占79.0%（64/81），发生感染时中位中性粒细胞绝对计数为0.24×10(9)/L。CRPA的独立风险因素是感染前平均住院时间长（P=0.013，OR=1.045）和30 d内曾经使用碳青霉烯类药物（P=0.005，OR=8.132）。81例患者30 d全因病死率为29.6%（24/81）；归因病死率为13.6%（11/81）；肺部感染是主要死亡原因，占41.7%（10/24）。CRPA组30 d全因病死率显著高于CSPA组[60.9%（14/23）比17.2%（10/58），P<0.001]。采用多变量logistic回归方法进行校正，仍证明碳青霉烯类耐药感染与30 d病死率存在显著相关性（P=0.011，OR=5.427），独立预后因素为年龄、碳青霉烯类耐药、感染发生前粒细胞缺乏持续时间和感染发生时功能状态。 结论： 血液病患者CRPA感染后病死率高、预后差；肺部是主要感染部位，肺部CRPA感染是血液病患者重要死亡原因，应密切监测并探索更为有效的治疗措施。.
Keywords: Carbapenem resistance; Hematologic diseases; Mortality; Pseudomonas aeruginosa.