单倍体造血干细胞移植患者移植前碳青霉烯类耐药肠杆菌肠道定植筛查和临床意义  

Screening and clinical significance of intestinal colonization of carbapenem⁃resistant Enterobacteriaceae(CRE)in patients before haploidentical hematopoietic stem cell transplantation

作　　者：吴雯琪 张雨琪 徐杰[1,2] 汤在祥 李诗佳[1,2] 魏西雅 李玲 吴河清[1,2] 马骁 刘济生 吴德沛[1,2] 吴小津 WU Wenqi;ZHANG Yuqi;XU Jie;TANG Zaixiang;LI Shijia;WEI Xiya;LI Ling;WU Heqing;MA Xiao;LIU Jisheng;WU Depei;WU Xiaojin(Department of Hematopathology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;National Clini-cal Research Center for Hematologic Diseases,Jiangsu Institute of Hematology;School of Public Health,Soochow University;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Soochow University)

机构地区：[1]苏州大学附属第一医院血液科,江苏苏州215000 [2]国家血液病临床医学研究中心江苏省血液研究所 [3]苏州大学公共卫生学院 [4]苏州大学附属第一医院耳鼻咽喉头颈外科

出　　处：《中国输血杂志》2023年第6期496-500,共5页Chinese Journal of Blood Transfusion

基　　金：国家自然科学基金(82171159,81974001,82170222);江苏省自然科学基金(BK2021107);江苏省卫生健康委科研项目(ZD2021008);苏州市卫生健康委科研项目(LCZX202101);国家科技重大专项课题(2017ZX09304021);国家重点研发计划(2019YFC0840604,2017YFA0104500);江苏省临床医学中心建设(YXZXA2016002)。

摘　　要：目的探讨单倍体造血干细胞移植(haploidentical hematopoietic stem cell transplantation,haplo⁃HSCT)前筛查碳青霉烯类耐药肠杆菌(carbapenem⁃resistant Enterobacteriaceae,CRE)肠道定植的结果和临床意义。方法纳入2021年6月1日至2022年6月1日在苏州大学附属第一医院行单倍体造血干细胞移植的血液病患者241名,在患者入院48 h内行肛拭子筛查,患者出现发热时抽取血培养。同时采用单因素和多因素统计方法对患者CRE肠道定植率、影响因素、病原菌分布情况及CRE定植和血流感染的相关性进行了分析。结果241名haplo⁃HSCT患者中CRE阳性患者90例,定植率为37.3%。多因素logistic回归分析结果示男性(OR 2.42,95%CI 1.38⁃4.22,P<0.05)和移植前30 d内感染史(OR 3.37,95%CI 1.59⁃7.17,P<0.05)可能是CRE肠道定植的独立危险因素。90例患者共检出95株CRE菌株,排列前5位的分别是耐碳青霉烯类肺炎克雷伯菌(38/95,40.0%),耐碳青霉烯类大肠埃希菌(29/95,30.5%),耐碳青霉烯类阴沟肠杆菌(13/95,13.6%),耐碳青霉烯类产酸克雷伯菌(6/95,6.3%),耐碳青霉烯类奇异变形杆菌(3/95,3.1%)。在CRE定植组移植过程中血流感染发生率12.0%(29/241),非定植组3.3%(8/241),其中定植组血流感染的病原菌与CRE定植菌一致率达到100%。结论在患者haplo⁃HSCT期间肛拭子细菌培养有利于检出CRE肠道定植,为对重点菌群的主动监测,预防并控制感染提供一定的临床依据。Objective To investigate the situation of carbapenem⁃resistant Enterobacteriaceae(CRE)colonization in pa⁃tients undergoing haploidentical hematopoietic stem cell transplantation(haplo⁃HSCT).Methods A total of 241 consecutive patients who underwent haplo⁃HSCT in the First Affiliated Hospital of Soochow University from June 1,2021 to June 1,2022 were enrolled.Anal swab screening was performed within 48 hours of admission and blood cultures were taken when the pa⁃tient developed fever.Univariate and multivariate analysis were used to analyze the colonization rate,distribution,risk factors and the correlation between CRE colonization and post⁃transplant bloodstream infection(BSI).Results Among 241 patients with haplo⁃HSCT,there were 90 cases in CRE colonization positive group,with a colonization rate of 37.3%(90/241).Mul⁃tivariate logistic regression analysis showed that sex(OR 2.42,95%CI 1.38⁃4.22,P<0.05)and history of infection within 30 days before transplantation(OR 3.37,95%CI 1.59⁃7.17,P<0.05)may be independent risk factors for CRE intestinal coloni⁃zation.Of the 95 CRE strains,the top five species were carbap⁃enem⁃resistant Klebsiella pneumoniae(38/95,40.0%),carbap⁃enem⁃resistant Escherichia coli(29/95,30.5%),carbapenem⁃resistant Enterobacter cloacae(13/95,13.6%),carbapenem⁃re⁃sistant Klebsiella acidophilus(6/95,6.3%)and carbapenem⁃re⁃sistant Proteus mirabilis(3/95,3.1%).The incidence of post⁃transplant BSI was 12.0%(29/241)in the CRE⁃colonized group and 3.3%(8/241)in the non⁃colonized group.In the colonization group,100%of the pathogens of BSI were identical with those of CRE colonization.Conclusion Bacterial culture of a⁃nal swab during haplo⁃HSCT is helpful for detection of CRE colonization in intestinal tract,which provides some clinical ba⁃sis for active monitoring of key flora,prevention and control of infection.

关 键 词：单倍体造血干细胞移植 碳青霉烯类耐药肠杆菌 病原菌分布 主动筛查 移植后血流感染 

分 类 号：R457.7[医药卫生—治疗学] R457.1[医药卫生—临床医学]