The impact of carbapenem-resistance Pseudomonas aeruginosa infections on mortality of patients with hematological disorders
10.3760/cma.j.cn112138-20191104-00728
- VernacularTitle:碳青霉烯类耐药的铜绿假单胞菌感染对血液病患者病死率的影响
- Author:
Ju WEI
1
;
Qiuli ZHU
;
Zhe SUN
;
Chun WANG
Author Information
1. 南京医科大学附属上海一院临床医学院血液科 200080
- From:
Chinese Journal of Internal Medicine
2020;59(5):353-359
- CountryChina
- Language:Chinese
-
Abstract:
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.
