背景:使用不合适的抗生素是死亡率增加的重要风险因素,发病率,以及正在接受血液系统恶性肿瘤(HM)和血流感染(BSI)治疗的患者的经济负担。这种不合适的治疗选择加剧了抗性变体的进化,这是由于可能的医疗保健相关感染传播到普通人群而引起的公共卫生问题。因此,本研究旨在评估BSI患者的抗菌谱和与败血症相关的危险因素。
方法:在来自美国国家癌症护理和研究中心(NCCCR)的513例HM患者中,共1166例发热性中性粒细胞减少症发作(FNE),卡塔尔,2009-2019年期间用于本研究。社会人口,临床,微生物,并使用从患者健康记录中检索的抗微生物数据。
结果:我们分析了在HM-FN-BSI患者中报告的革兰氏阴性和革兰氏阳性杆菌的敏感性。在总共512个分离的微生物中,416例(81%)为革兰阴性菌(GNB),革兰氏阳性菌(GPB)76例(15%),真菌20例(4%)。此外,在416GNB,298(71.6%)是肠杆菌科。其中121例(41%)对第三代头孢菌素和哌拉西林他唑巴坦耐药的ESBL(超广谱β-内酰胺酶),54(18%)是耐碳青霉烯或耐多药生物(MDRO)。值得注意的是,我们医院的主要感染因子包括大肠杆菌,克雷伯菌属,还有铜绿假单胞菌.在整个研究期间,BSI导致的死亡率为23%.与死亡显着相关的危险因素是年龄,疾病状态,单微生物或多微生物BSI和脓毒性休克。
结论:关于HM-FN-BSI患者使用抗菌药物的决定是一项关键任务,它依赖于最新的流行模式,治疗抗性,和临床结果。对卡塔尔HM-FN-BSI患者的抗菌谱进行分析,要求重新考虑目前遵循的经验性抗生素治疗,以更好地控制感染和抗菌药物管理。
BACKGROUND: The use of ill-suited antibiotics is a significant risk factor behind the increase in the mortality, morbidity, and economic burden for patients who are under treatment for hematological malignancy (HM) and bloodstream infections (BSI). Such unfitting treatment choices intensify the evolution of resistant variants which is a public health concern due to possible healthcare-associated infection spread to the general population. Hence, this
study aims to evaluate antibiograms of patients with BSI and risk factors associated with septicemia.
METHODS: A total of 1166 febrile neutropenia episodes (FNE) among 513 patients with HM from the National Center for Cancer Care and Research (NCCCR), Qatar, during 2009-2019 were used for this
study. The socio-demographic, clinical, microbial, and anti-microbial data retrieved from the patient\'s health records were used.
RESULTS: We analyzed the sensitivity of gram-negative and gram-positive bacilli reported in HM-FN-BSI patients. Out of the total 512 microorganisms isolated, 416 (81%) were gram-negative bacteria (GNB), 76 (15%) were gram-positive bacteria (GPB) and 20 (4%) were fungi. Furthermore, in 416 GNB, 298 (71.6%) were Enterobacteriaceae sp. among which 121 (41%) were ESBL (Extended Spectrum Beta-Lactamase) resistant to Cephalosporine third generation and Piperacillin-Tazobactam, 54 (18%) were Carbapenem-resistant or multidrug-resistant organism (MDRO). It\'s noteworthy that the predominant infectious agents in our hospital include E. coli, Klebsiella species, and P. aeruginosa. Throughout the
study period, the mortality rate due to BSI was 23%. Risk factors that show a significant correlation with death are age, disease status, mono or polymicrobial BSI and septic shock.
CONCLUSIONS: Decision pertaining to the usage of antimicrobials for HM-FN-BSI patients is a critical task that relies on the latest pattern of prevalence, treatment resistance, and clinical outcomes. Analysis of the antibiogram of HM-FN-BSI patients in Qatar calls for a reconsideration of currently followed empirical antibiotic therapy towards better infection control and antimicrobial stewardship.