■血流感染(BSI)是血液恶性肿瘤(HM)的常见并发症。通常,BSI患者通常在病原体鉴定之前进行经验性治疗。BSIs的及时有效管理显著影响患者预后。然而,BSIs中的病原体分布表现出区域差异。在这项研究中,我们调查了临床特征,病原体谱,耐药性,浙江省人民医院急性髓系白血病(AML)合并BSI患者近期预后的危险因素及远期预后因素分析.
■自2019年至2021年,浙江省人民医院血液科共收治56例AML合并BSI患者。收集有关病原体谱和耐药性的数据用于分析。患者在BSI后30天内分为非幸存者队列和幸存者队列,通过单因素和多因素Logistic回归分析确定了30天死亡率的预测因子.此外,采用Kaplan-Meier生存分析和Cox回归分析确定AML合并BSI患者预后不良的危险因素。
■从56例AML合并BSI患者中分离出70株病原菌。革兰阴性菌占主要病原菌(71.4%),肺炎克雷伯菌最普遍(22.9%)。革兰阳性菌和真菌分别占22.9%和5.7%,分别。单变量和多变量分析显示总蛋白存在显著差异,白蛋白水平,BSI后30天,非幸存者队列和幸存者队列之间存在感染性休克。COX回归分析显示,粒细胞缺乏持续时间超过20天(HR:3.854;95%CI:1.451-10.242)和感染性休克(HR:3.788;95%CI:1.729-8.299)是AML合并BSI患者预后不良的独立危险因素。值得注意的是,嗜麦芽窄食单胞菌感染后30天内的死亡率高达71.4%。
■在这项研究中,革兰氏阴性菌,主要是肺炎克雷伯菌,构成AML患者BSIs的主要病原体。在患有BSI的AML患者中,血清白蛋白水平和脓毒性休克的存在是30天内死亡的独立危险因素。就长期预后而言,在患有BSI的AML患者中,粒细胞缺乏持续时间超过20天和感染性休克与死亡率升高相关.此外,在我们的中心,发现嗜麦芽窄食单胞菌感染与预后不良有关。我们中心对嗜麦芽窄食单胞菌感染的早期干预可能会改善患者的预后。
UNASSIGNED: Bloodstream infection (BSI) represent a prevalent complication in haematological malignancies (HMs). Typically, Patients with BSI usually undergo empirical treatment pending pathogen identification. The timely and effective management of BSIs significantly influences patient prognosis. However, pathogen distribution in BSIs exhibits regional variation. In this study, we investigated the clinical characteristics, pathogen spectrum, drug resistance, risk factors of short-term prognosis and long-term prognostic factors of acute myeloid leukemia (AML) patients with BSI at Zhejiang Provincal People\'s Hospital.
UNASSIGNED: From 2019 to 2021, a total of 56 AML patients with BSI were treated in the Department of Haematology at Zhejiang Province People\'s Hospital. Data regarding pathogen spectrum and drug resistance were collected for analysis. The patients were stratified into non-survivor cohort and survivor cohort within 30 days after BSI, and the predictors of 30-days mortality were identified through both univariate and multivariate Logistic regression analyses. Furthermore, Kaplan-Meier survival analysis and Cox regression analysis were employed to ascertain the risk factors associated with poor prognosis in AML patients complicated by BSI.
UNASSIGNED: A total of 70 strains of pathogenic bacteria were isolated from 56 AML patients with BSI. Gram-negative bacteria constituted the predominant pathogens (71.4%), with Klebsiella pneumoniae being the most prevalent (22.9%). Gram-positive bacteria and fungi accounted for 22.9% and 5.7%, respectively. Univariate and multivariate analyses revealed significant differences in total protein, albumin levels, and the presence of septic shock between the non-survivor cohort and the survior cohort 30 days post-BSI. COX regression analysis showed that agranulocytosis duration exceeding 20 days (HR:3.854; 95% CI: 1.451-10.242) and septic shock (HR:3.788; 95% CI: 1.729-8.299) were independent risk factors for poor prognosis in AML patients complicated by BSI. Notably, the mortality rate within 30 days after Stenotrophomonas maltophilia infection was up to 71.4%.
UNASSIGNED: In this study, Gram-negative bacteria, predominantly Klebsiella pneumoniae, constituted the primary pathogens among AML patients with BSIs. Serum albumin levels and the presence of septic shock emerged as independent risk factors for mortality within 30 days among AML patients with BSI. In terms of long-term prognosis, extended agranulocytosis duration exceeding 20 days and septic shock were associated with elevated mortality rates in AML patients with BSI. Additionally, in our centre, Stenotrophomonas maltophilia infection was found to be associated with a poor prognosis. Early intervention for Stenotrophomonas maltophilia infection in our centre could potentially improve patient outcomes.