Analysis of Pathogenic Bacterial Spectrum, Drug Resistance and Risk Factors for Mortality of Bloodstream Infection in Patients with Hematologic Diseases.
10.19746/j.cnki.issn.1009-2137.2023.05.048
- Author:
Qian GUO
1
;
Xin-Wei WANG
2
;
Xin-Yue CHEN
2
;
Jie ZHAO
3
;
Shao-Long HE
3
;
Wei-Wei TIAN
3
;
Liang-Ming MA
3
Author Information
1. Department of Laboratory Medicine, Fenyang Hospital Affiliated to Shanxi Medical University, Fenyang 032200, Shanxi Province, China.
2. School of Public Health, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China.
3. Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China.
- Publication Type:Journal Article
- Keywords:
pathogenic bacteria;
bloodstream infection;
drug-resistance;
mortality
- MeSH:
Humans;
Middle Aged;
Bacteremia/mortality*;
Bacteria/isolation & purification*;
Drug Resistance;
Drug Resistance, Bacterial;
Gram-Negative Bacteria;
Hematologic Diseases/complications*;
Methicillin-Resistant Staphylococcus aureus;
Retrospective Studies;
Risk Factors;
Sepsis/mortality*
- From:
Journal of Experimental Hematology
2023;31(5):1556-1562
- CountryChina
- Language:Chinese
-
Abstract:
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.
