碳青霉烯耐药革兰阴性杆菌感染的血液病患者的临床特征及30天内死亡危险因素分析  

Clinical Characteristics and Risk Factors for 30-Day Mortality in Patients with Hematologic Diseases Infected by Carbapenem-Resistant Organisms

作　　者：陈新月 侯辰蕊 赵洁[3] 贺少龙[3] 卢馨怡 郭晓烨 王瑞雪 马梁明[3] 魏俊妮[1] 田卫伟 CHEN Xin-Yue;HOU Chen-Rui;ZHAO Jie;HE Shao-Long;LU Xin-Yi;GUO Xiao-Ye;WANG Rui-Xue;MA Liang-Ming;WEI Jun-Ni;TIAN Wei-Wei(School of Public Health,Shanxi Medical University;Department of Clinical Laboratory,The Third Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;Department of Hematology,The Third Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;Department of Information,The Third Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学公共卫生学院 [2]山西医科大学第三医院检验科,山西太原030001 [3]山西医科大学第三医院血液内科,山西太原030001 [4]山西医科大学第三医院信息科,山西太原030001

出　　处：《中国实验血液学杂志》2023年第4期1199-1204,共6页Journal of Experimental Hematology

基　　金：山西省卫生健康委一般项目(2020012)。

摘　　要：目的:探讨血液病住院患者合并碳青霉烯耐药革兰阴性杆菌(CRO)感染的临床特征及分析30 d全因死亡的危险因素。方法:回顾性分析2015年1月至2020年12月于山西医科大学第三医院血液内科住院的77例血液病合并CRO感染患者的临床资料及实验室检查资料,采用多因素Logistic回归分析影响患者感染后30 d死亡的危险因素。结果:77例血液病合并CRO感染的患者中,感染30 d内死亡29例,存活48例,病死率达37.66%。在这些患者中共检出93株病原菌,其中鲍曼不动杆菌检出率最高(25.81%,24/93),其次为铜绿假单胞菌(18.28%,17/93)。肺部是CRO感染最常见的部位。检出病原菌对碳青霉烯类药物高度耐药,对亚胺培南耐药最低抑菌浓度(MIC)≥16μg/ml的占64.52%(60/93)。单因素分析结果显示,确诊CRO感染时白蛋白浓度<25 g/L(P=0.048)、血肌酐浓度≥120μmol/L(P=0.023)、年龄校正查尔森共病指数(ACCI)(P=0.037)以及原发病的治疗方法(支持治疗、免疫抑制剂治疗、化疗、HSCT)(P=0.048)与感染后30 d全因死亡显著相关;多因素Logistic回归分析结果显示,确诊CRO感染时白蛋白浓度<25 g/L(P=0.014,OR=6.171)、血肌酐浓度≥120μmol/L(P=0.009,OR=10.867)是血液病患者合并CRO感染30d内死亡的独立危险因素。结论:血液病合并CRO感染的患者病死率高,检出病原菌对亚胺培南高度耐药,确诊感染时白蛋白浓度<25 g/L和血肌酐浓度≥120μmol/L是患者感染后30 d内死亡的独立危险因素。Objective:To explore the clinical characteristics of hospitalized patients with hematologic diseases complicated with carbapenem-resistant organisms(CRO)infection and analyze the risk factors of 30-day all-cause mortality.Methods:The clinical data and laboratory test data of 77 hospitalized patients with hematologic diseases complicated with CRO infection in department of hematology of the Third Hospital of Shanxi Medical University from January 2015 to December 2020 were retrospectively analysed,the risk factors of 30-day all-cause mortality after CRO infection were analyzed by multivariate logistic regression.Results:Among the total of 77 patients with hematologic diseases complicated with CRO infection,29 died and 48 survived within 30 days of infection,with a case fatality rate of 37.66%.A total of 93 strains of CRO were isolated from these patients,of which Acinetobacter baumannii had the highest detection rate(25.81%,24/93),followed by Pseudomonas aeruginosa(18.28%,17/93).The lung was the most common site of CRO infection.The detected pathogens were highly resistant to carbapenems,and 64.52%(60/93)of the pathogens were resistant to imipenem with minimum inhibitory concentration(MIC)≥16μg/ml.The results of the univariate analysis showed that albumin concentration<25 g/L(P=0.048),serum creatinine concentration≥120μmol/L(P=0.023),age-adjusted Charlson comorbidity index(ACCI)(P=0.037)and primary treatments(supportive treatment,immunosuppressive therapy,chemotherapy,HSCT)(P=0.048)were significantly associated with 30-day all-cause mortality after infection.The results of multivariate logistic regression analysis showed that when CRO infection confirmed,albumin concentration<25 g/L(P=0.014,OR=6.171),serum creatinine concentration≥120μmol/L(P=0.009,OR=10.867)were independent risk factors for 30-day mortality of patients with hematologic diseases complicated with CRO infection.Conclusion:The mortality rate of CRO-infected patients with hematologic diseases is high.The detected pathogenic bacteria are highl

关 键 词：血液病 碳青霉烯类耐药 革兰阴性杆菌 感染 预后 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R733[医药卫生—临床医学]