Clinical and genomic characterization of carbapenem-resistant Enterobacterales bloodstream infections in patients with hematologic malignancies.

IF 4.6 2区医学 Q2 IMMUNOLOGY

Frontiers in Cellular and Infection Microbiology Pub Date : 2024-09-26 eCollection Date: 2024-01-01 DOI:10.3389/fcimb.2024.1471477

Yi Chen, Jiangqing Huang, Luyan Dong, Binbin Xu, Lei Li, Zhichang Zhao, Bin Li

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Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) pose a significant risk to patients with hematologic malignancies, yet the distinct features and outcomes of these infections are not thoroughly understood.

Methods: This retrospective study examined the characteristics and clinical outcomes of patients with Enterobacterales BSIs at the Hematology Department of Fujian Medical University Union Hospital from 2018 to 2022. Whole-genome sequencing was conducted on 45 consecutive CRE BSI isolates during this period.

Results: A total of 301 patients with Enterobacterales BSIs were included, with 65 (21.6%) cases of CRE and 236 (78.4%) cases of carbapenem-susceptible Enterobacterales (CSE). CRE infections accounted for 16.9% to 26.9% of all Enterobacterales BSIs, and carbapenem-resistant Klebsiella pneumoniae (CRKP) was the predominant strain. The most frequent sequence type (ST) and carbapenemase among CRKP were ST11 (68.6%) and blaKPC-2 (80.0%), respectively. Perianal infections, multiple infection foci, and a history of multiple hospitalizations, ICU stays, and prior CRE infections were identified as risk factors for CRE BSIs. Patients in the CRE group experienced significantly higher proportions of infection-related septic shock (43.1% vs. 19.9%, P < 0.0003) and 30-day all-cause mortality (56.9% vs. 24.6%, P < 0.0001) compared to those in the CSE group. Patient's age and disease subtypes, strain subtypes, and antimicrobial treatment regimens significantly influenced survival in patients with CRE BSIs.

Conclusions: CRE BSIs are a frequent complication in patients with hematological malignancies undergoing treatment and are associated with poor survival rates. A comprehensive understanding of risk factors and ongoing surveillance of prevalent strains are essential for the effective management of these infections.

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血液系统恶性肿瘤患者耐碳青霉烯类肠杆菌血流感染的临床和基因组特征。

背景：耐碳青霉烯类肠杆菌（CRE）血流感染（BSIs）对血液系统恶性肿瘤患者构成重大风险，但这些感染的不同特征和结局尚未被彻底了解：这项回顾性研究考察了2018年至2022年福建医科大学附属协和医院血液科肠杆菌BSIs患者的特征和临床结局。在此期间，对45例连续分离出的CRE BSI进行了全基因组测序：共纳入301例肠杆菌BSI患者，其中65例（21.6%）为CRE，236例（78.4%）为碳青霉烯类易感肠杆菌（CSE）。CRE感染占所有肠杆菌BSI的16.9%至26.9%，耐碳青霉烯类肺炎克雷伯菌（CRKP）是主要菌株。CRKP 中最常见的序列类型（ST）和碳青霉烯酶分别是 ST11（68.6%）和 blaKPC-2（80.0%）。肛周感染、多个感染灶、多次住院史、重症监护室住院史和既往 CRE 感染史被确定为 CRE BSI 的风险因素。与CSE组患者相比，CRE组患者发生感染相关脓毒性休克（43.1% vs. 19.9%，P < 0.0003）和30天全因死亡率（56.9% vs. 24.6%，P < 0.0001）的比例明显更高。患者的年龄、疾病亚型、菌株亚型和抗菌治疗方案对CRE BSI患者的存活率有显著影响：CRE BSIs是接受治疗的血液恶性肿瘤患者的一种常见并发症，与不良生存率有关。全面了解风险因素和持续监测流行菌株对于有效控制这些感染至关重要。

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来源期刊

Frontiers in Cellular and Infection Microbiology IMMUNOLOGY-MICROBIOLOGY

CiteScore

7.90

自引率

7.00%

发文量

1817

审稿时长

14 weeks

期刊介绍： Frontiers in Cellular and Infection Microbiology is a leading specialty journal, publishing rigorously peer-reviewed research across all pathogenic microorganisms and their interaction with their hosts. Chief Editor Yousef Abu Kwaik, University of Louisville is supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Cellular and Infection Microbiology includes research on bacteria, fungi, parasites, viruses, endosymbionts, prions and all microbial pathogens as well as the microbiota and its effect on health and disease in various hosts. The research approaches include molecular microbiology, cellular microbiology, gene regulation, proteomics, signal transduction, pathogenic evolution, genomics, structural biology, and virulence factors as well as model hosts. Areas of research to counteract infectious agents by the host include the host innate and adaptive immune responses as well as metabolic restrictions to various pathogenic microorganisms, vaccine design and development against various pathogenic microorganisms, and the mechanisms of antibiotic resistance and its countermeasures.