血液肿瘤患者肛拭子耐碳青霉烯类肠杆菌目主动筛查情况及继发血流感染的影响因素

Active screening of Carbapenem resistant enterobacterales from anal swabs of patients with hematological tumors and influencing factors of secondary bloodstream infection

摘要:

目的 探讨血液肿瘤患者肛拭子耐碳青霉烯类肠杆菌（CRE）主动筛查情况及继发血流感染的影响因素。方法 选取2020年9月—2022年6月在苏州大学附属第一医院治疗的血液肿瘤患者1 258例，所有患者行肛拭子CRE主动筛查，分析CRE定植分布、血流感染情况及其影响因素。结果 共检出CRE 109株，以肺炎克雷伯菌、大肠埃希菌为主；10例患者发生CRE血流感染；CRE酶型分布中，主要以NDM、KPC为主；有中性粒细胞缺乏患者CRE定植发生率高于无中性粒细胞缺乏患者（P <0.05）；有消化道症状患者CRE定植发生率高于无消化道症状患者（P <0.05）；多因素逐步Logistic回归分析结果显示，中性粒细胞缺乏［O^R=2.252（95% CI：1.570，3.231）］是血液肿瘤患者CRE定植发生的影响因素（P <0.05）。不同性别、年龄、疾病类型及有无中性粒细胞缺乏、消化道症状患者的血流感染发生率比较，差异均无统计学意义（P >0.05）。结论 血液肿瘤患者肛拭子CRE主动筛查能有效筛出CRE感染者，CRE定植感染与中性粒细胞缺乏有关，临床应加以重视。

Abstract:

Objective To investigate the active screening for carbapenem-resistant Enterobacteriaceae (CRE) in anal swabs of hematologic malignancy patients and factors influencing secondary bloodstream infections.Methods A total of 1,258 hematologic malignancy patients treated at the First Affiliated Hospital of Soochow University from September 2020 to June 2022 were included in this study. All patients underwent active screening for CRE using anal swabs. The study analyzed the distribution of CRE colonization, the occurrence of bloodstream infections, and associated factors.Results A total of 109 CRE strains were detected, primarily including Klebsiella pneumoniae and Escherichia coli. Ten patients developed CRE bloodstream infections. The dominant CRE enzyme types were NDM and KPC. The colonization rate of CRE in patients with neutropenia was higher than in those without neutropenia (P < 0.05). Patients with gastrointestinal symptoms had a higher CRE colonization rate compared to those without gastrointestinal symptoms (P < 0.05). Multifactorial stepwise logistic regression analysis showed that neutropenia [O^R = 2.252 (95% CI: 1.570, 3.231) ] was a significant factor associated with CRE colonization in hematologic malignancy patients (P < 0.05). No statistically significant differences were observed in the occurrence of bloodstream infections based on gender, age, disease type, presence of neutropenia, or gastrointestinal symptoms (P > 0.05).Conclusion Active screening for CRE in anal swabs of hematologic malignancy patients is an effective method to identify CRE carriers. CRE colonization is associated with neutropenia, and this should be clinically addressed.