Objective: To observe the clinical characteristics and impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonized or infected patients with hematological disorders in order to provide evidence for the prevention and treatment of CRPA.
Methods: The patients who were colonized or infected with CRPA in the Department of Hematology of The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to March 2021 were selected as the research subjects, the clinical data such as hospitalization time, primary disease treatment regimen, granulocyte count, previous infection and antibiotic regimen of these patients were analyzed, meanwhile, antibiotic regimen and efficacy during CRPA infection, 30-day and long-term survival were also analyzed.
Results: A total of 59 patients were included in this study, and divided into CRPA infection group (43 cases) and CRPA colonization group (16 cases). Univariate logistic regression analysis showed that ECOG score (P =0.003), agranulocytosis (P <0.001), and exposure to upper than 3rd generations of cephalosporins and tigecycline within 30 days (P =0.035, P =0.017) were the high-risk factors for CRPA infection. Multivariate logistic regression analysis showed that ECOG score of 3/4 ( OR=10.815, 95%CI: 1.260-92.820, P =0.030) and agranulocytosis ( OR=13.82, 95%CI: 2.243-85.176, P =0.005) were independent risk factors for CRPA infection. There was a statistically significant difference in cumulative survival rate between CRPA colonization group and CRPA infection group ( χ2=14.134, P < 0.001). Kaplan-Meier survival analysis showed that the influencing factors of 30-day survival in patients with CRPA infection were agranulocytosis (P =0.022), soft tissue infection (P =0.03), and time of hospitalization before CRPA infection (P =0.041). Cox regression analysis showed that agranulocytosis was an independent risk factor affecting 30-day survival of patients with CRPA infection (HR=3.229, 95%CI :1.093-3.548, P =0.034).
Conclusions: Patients with hematological disorders have high mortality and poor prognosis after CRPA infection. Bloodstream infection and soft tissue infection are the main causes of death. Patients with high suspicion of CRPA infection and high-risk should be treated as soon as possible.
题目: 血液病患者定植或感染碳青霉烯类耐药的铜绿假单胞菌的临床特征及生存分析.
目的: 观察血液病患者定植或感染碳青霉烯类耐药的铜绿假单胞菌（CRPA）的临床特征及对病死率的影响，为预防和治疗CRPA提供依据。.
方法: 以2020年1月至2021年3月在浙江省中医院血液科定植或感染CRPA的患者为研究对象，分析此类患者的住院时间、原发病治疗方案、粒细胞数、既往感染情况及抗生素使用情况等临床资料，同时分析患者在CRPA感染治疗期间的抗生素方案以及治疗疗效、30 d及长期生存情况。.
结果: 本研究共纳入59例患者，分为CRPA感染组43例，CRPA定植组16例。单因素分析显示，ECOG评分（P =0.003）、粒细胞缺乏（P <0.001）、30 d内暴露3代以上头孢及替加环素（P =0.035，P =0.017）为发生CRPA感染的高危因素；多变量Logistic回归分析 显示，ECOG评分为3/4分（ OR=10.815，95%CI：1.260-92.820，P =0.030）、粒细胞缺乏（ OR=13.82，95%CI: 2.243- 85.176，P =0.005）是发生CRPA感染的独立危险因素。CRPA定植组和感染组累计生存率比较，差异有统计学差异（ χ2=14.134，P <0.001）。Kaplan-Meier生存分析显示，CRPA感染患者30 d生存的影响因素为粒细胞缺乏（P =0.022）、软组织感染（P =0.03）和CRPA感染的前次住院时间（P =0.041）。COX回归分析显示，影响CRPA感染患者30 d内生存的独立危险因素为粒细胞缺乏（HR=3.229，95%CI ：1.093-3.548，P =0.034）。.
结论: 血液病患者CRPA感染后病死率 高、预后差。血流感染及软组织感染是主要死亡原因。对于高度怀疑CRPA感染且存在高危风险患者应尽早治疗。.
Keywords: carbapenem-resistant Pseudomonas aeruginosa; clinical characteristics; hematological disorder; survival analysis.