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张为利, 黄杰, 吴思颖等. 血液肿瘤患者大肠埃希菌血流感染的耐药性及死亡危险因素分析[J]. 四川大学学报(医学版), 2018, 49(1): 133-135.
引用本文: 张为利, 黄杰, 吴思颖等. 血液肿瘤患者大肠埃希菌血流感染的耐药性及死亡危险因素分析[J]. 四川大学学报(医学版), 2018, 49(1): 133-135.
ZHANG Wei-li, HUANG Jie, WU Si-ying. et al. Antibiotic Resistance and Risk Factors for Mortality of Blood Stream Infections (BSIs) with Escherichia coli in Patients with Hematological Malignancies[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(1): 133-135.
Citation: ZHANG Wei-li, HUANG Jie, WU Si-ying. et al. Antibiotic Resistance and Risk Factors for Mortality of Blood Stream Infections (BSIs) with Escherichia coli in Patients with Hematological Malignancies[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(1): 133-135.

血液肿瘤患者大肠埃希菌血流感染的耐药性及死亡危险因素分析

Antibiotic Resistance and Risk Factors for Mortality of Blood Stream Infections (BSIs) with Escherichia coli in Patients with Hematological Malignancies

  • 摘要: 目的 了解四川大学华西医院血液肿瘤患者大肠埃希菌血流感染的耐药性及死亡危险因素,为其治疗和预后提供参考。 方法 采用病例对照研究,选择近5年我院110例血液肿瘤患者大肠埃希菌血流感染为研究对象,比较感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌组(产ESBLs组,n=77)与非产ESBLs大肠埃希菌组(非产ESBLs组,n=33)患者的耐药性及临床特征;同时比较30 d内死亡者(死亡组,n=20)与存活者(成活组, n=64)死亡的危险因素。 结果 大肠埃希菌对碳青霉烯类和阿米卡星的耐药率低于10%。产ESBL组和非产ESBL组患者的临床症状、既往抗生素/抗真菌药使用、易感因素、30 d死亡率差异均无统计学意义(P>0.05)。Logistic回归分析发现血液肿瘤未缓解(比值比=9.575,95%可信区间1.546~59.312,P=0.015)和早期不合理使用抗生素(比值比=8.806,95%可信区间1.527~50.772,P=0.015)是大肠埃希菌血流感染30 d内死亡的独立危险因素。 结论 早期快速启动有效抗菌治疗(碳青霉烯类,必要时联合阿米卡星)可降低血液肿瘤患者大肠埃希菌血流感染死亡风险。

     

    Abstract: Objective To analyze the risk factors for mortality of blood stream infections (BSIs) caused by Escherichia coli in the patients with hematological malignancies. Methods There were 110 Escherichia coli BSIs patients with hematological malignancies included in recent five years. Among them, 77 cases had BSIs caused by extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC group), while 33 cases had BSIs with non-ESBL-producing Escherichia coli (non-ESBL-EC group). The antibiotic resistance and clinical features were compared between the two groups, and the risk factors for death within 30 d were analyzed. Results Less than 10% of the isolates were resistant to carbapenems and amikacin. Between ESBL-EC group and non-ESBL-EC group, the clinical symptoms, prior use of antibiotics or antifungal agents, risk factors for infection, 30 d mortality rates were not significantly different (P>0.05). A logistic regression analysis confirmed that non remission of hematologic malignancies (odds ratio=9.575, 95% confidence interval 1.546-59.312, P=0.015) and inappropriate initial antibiotic therapy (odds ratio=8.806, 95% confidence interval 1.527-50.772,P=0.015) were independent risk factors for 30 d mortality. Conclusion The use of effective antimicrobial treatment as early as possible could reduce the risk of death for hematological malignancies patients suffering Escherichia coli BSIs.

     

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