抗菌疗程持续时间和类别对AML患者产生耐药革兰阴性杆菌血流感染风险的影响。
Effects of antimicrobial therapy duration and class on risk of antimicrobial-resistant Gram-negative bacillus bloodstream infection in patients with AML.
发表日期：2023 Aug 14
作者：
Jonathan Huggins, Ian Barnett, Michael Z David
来源：
MEDICINE & SCIENCE IN SPORTS & EXERCISE
摘要：
抗菌药物耐药的革兰氏阴性杆菌（ARGNB）血流感染（BSI）与造血恶性肿瘤患者之前接受的抗生素有关。对于治疗天数（DOT）、抗菌药物种类和ARGNB BSI风险之间的关系了解甚少。本研究为一家单中心的病例对照研究，包括2007年1月1日至2018年12月31日期间的115例含ARGNB BSI的急性髓系白血病（AML）患者病例和230例非ARGNB BSI的匹配对照病例。利用固定效应和混合效应逻辑回归分析了抗生素治疗天数与ARGNB BSI风险之间的关系。入住重症监护病房（ICU）7天内、30天死亡率和Pitt细菌血症评分（PBS）作为次要结果。先前分离出的抗菌药物耐药菌（ARO）（OR 4.45，95% CI 1.46，13.54），手术在90天内（OR 3.71，95% CI 1.57，8.73），氨基糖苷类药物治疗天数（OR 1.14，95% CI 1.05，1.23），头孢曲松治疗天数（OR 1.09，95% CI 1.05，1.13）和碳青霉烯类药物治疗天数（OR 1.10，95% CI 1.05，1.16）与ARGNB BSI的几率增加相关。最后一次抗生素使用后的天数（OR 0.98，95% CI 0.97，0.99）和90天内的住院天数（OR 0.95，95% CI 0.93，0.98）显示ARGNB BSI的几率降低。无论类别如何，总抗菌药物治疗天数与ARGNB BSI无关。ARGNB BSI与30天死亡率增加相关（OR 2.86，95% CI 1.57，5.22）。结论：AML患者在BSI前90天内更大程度地使用氨基糖苷类药物、头孢曲松和碳青霉烯类药物与ARGNB BSI的几率增加相关。© 2023 Wiley Periodicals LLC.
Antimicrobial-resistant Gram-negative bacilli (ARGNB) bloodstream infection (BSI) has been associated with prior antibiotic exposure among hematologic malignancy patients. The relationships between days of therapy (DOT), antimicrobial class, and ARGNB BSI risk are poorly understood.This is a single-center, case-control study of acute myeloid leukemia (AML) patients including 115 cases with ARGNB BSI and 230 matched controls with non-ARGNB BSI between January 1, 2007 and December 31, 2018. Fixed- and mixed-effects logistic regression was used to examine relationships between antibiotic DOT and risk of ARGNB BSI. Admission to an intensive care unit (ICU) within 7 days, 30-day mortality, and Pitt Bacteremia Score (PBS) were secondary outcomes.Prior isolation of a antimicrobial-resistant organism (ARO) (OR 4.45 95% CI 1.46, 13.54), surgery within 90 days (OR 3.71, 95% CI 1.57, 8.73), aminoglycoside DOT (OR 1.14, 95% CI 1.05, 1.23), cefepime DOT (OR 1.09, 95% CI 1.05, 1.13), and carbapenem DOT (OR 1.10, 95% CI 1.05, 1.16) were associated with increased odds of ARGNB BSI. Days since last antibiotic administration (OR 0.98, 95% CI 0.97, 0.99) and inpatient days within 90 days (OR 0.95, 95% CI 0.93, 0.98) showed reduced odds of ARGNB BSI. Total antimicrobial DOT regardless of class was not associated with ARGNB BSI. ARGNB BSI was associated with increased 30-day mortality (OR 2.86, 95% CI 1.57, 5.22) CONCLUSIONS: Among AML patients with GNB BSI, greater DOT of aminoglycosides, cefepime, and carbapenems in the 90 days prior to BSI were associated with increased odds of ARGNB BSI.© 2023 Wiley Periodicals LLC.