RESUMEN
Objective: To investigate the clinical and laboratory features of Aeromonas bacteremia in patients with hematological diseases, and provide evidence for the prevention and treatment of Aeromonas infection. Methods: A retrospective study of patients with bloodstream infection of Aeromonas in our hospital from January 2014 to December 2018 was carried out. The clinical characteristics, antimicrobial susceptibility, infection seasons, antimicrobial therapy and evolution were analyzed. Results: A total of 42 patients with hematological diseases had Aeromonas bloodstream infection within 5 years. Among them, 39 cases (92.9%) of bloodstream infection occurred in the stage of neutropenia. The median time of fever was 4 (1-27) d, 22 (52.4%) patients only had fever, 6 (14.3%) with gastrointestinal symptoms (abdominal pain, diarrhea, nausea, upper gastrointestinal bleeding) , 8 (19.0%) with pulmonary infection, 13 (31.0%) with skin and soft tissue infections. Seven patients (16.7%) died with skin and soft tissue infection. The resistance of Aeromonas to carbapenems was 68.3%-70.7%, while the resistance rate to cephalosporins, quinolones and aminoglycosides were less than 10%. Conclusions: Aeromonas bacteremia in patients with hematological diseases mainly occur in the neutropenia stage, usually with symptom like fever. The mortality is increased when accompanied by skin and soft tissue infection. Antibiotic use should be based on susceptibility results, and avoid the use of carbapenems.
Asunto(s)
Aeromonas , Bacteriemia , Enfermedades Hematológicas , Antibacterianos , Análisis de Datos , Humanos , Estudios RetrospectivosRESUMEN
Objective: To analyze the hints role of surveillance cultures of Carbapenem-resistant Enterobacteriaceae (CRE) by perianal swabs in patients with hematological diseases, and seek risk factors of CRE bloodstream infection. Methods: The resistance of CRE from 2 914 patients with hematological diseases who cultured perianal swabs, CRE bloodstream infection and risk factors were analyzed during January 2016 to December 2017. Results: In this study, perianal swabs from 2 914 patients with hematological diseases were cultured, 74 patients were CRE positive, and bloodstream infection with CRE was found in 13 of these patients. A total of 87 CRE strains were isolated (The same patient only keep the first one for the same location), including 31 Klebsiella pheuminiae, 43 Escherichia coli, 8 Enterobacter cloacae and 6 other Enterobacteriaceae. The resistance rates to piperacillin / tazobactam, imipenem, meropenam, amikacin, levofloxacin, tigecycline were 91.9%, 74.4%, 98.8%, 17.6%, 74.4% and 8.0%, respectively. Resistance to carbapenem, aminoglycoside, quinolones and tegacycline were highly consistent between two sites from 13 patients, whose both perianal swabs and blood were positive in CRE cultures. Febrile neutropenic time, digestive tract symptoms and perianal infection were independent risk factors for bloodstream infection in patients with perianal swabs positive results, the odds ratios (OR) were 1.10 (P=0.029), 1.13 (P=0.005) and 1.23 (P=0.016), respectively. Conclusion: Perianal swabs surveillance cultures of CRE can be hints for CRE bloodstream infection in patients with hematological diseases, and also can provide suggestions for antibiotics. Long time of febrile neutropenic, digestive tract symptoms and perianal infection can be the early warning for CRE bloodstream infections.
Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos , Infecciones por Enterobacteriaceae , Antibacterianos , Bacteriemia , Carbapenémicos , Enfermedades Hematológicas , HumanosRESUMEN
OBJECTIVE: To conduct a systematic review and meta-analysis of the performance of the procalcitonin (PCT) diagnostic test for identifying infectious complications after hematopoietic stem cell transplantation (HSCT). METHODS: We searched EMBASE, MEDLINE, the Cochrane database, and reference lists of relevant articles, with no language restrictions, through December 2011. We selected original articles that reported diagnostic performance of PCT alone or compared with other biomarkers for identifying serious infections in HSCT recipients. We quantitatively evaluated test accuracy parameters with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effect models. RESULTS: We found 6 qualifying studies (studying 1344 episodes of suspected infection with confirmed infectious episodes) from 3 countries. These 6 studies examined both PCT and C-reactive protein (CRP) test performance. Bivariate pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 0.66 (95% confidence interval [CI] 0.60-0.72), 0.72 (95% CI 0.65-0.79), 2.39 (95% CI 1.84- 3.09), and 0.47 (95% CI 0.39-0.57) for PCT, and 0.80 (95% CI 0.54-0.93), 0.73 (95% CI 0.56-0.86), 3.00 (95% CI 1.86-4.84), and 0.27 (95% CI 0.11-0.65) for CRP. In terms of area under the curve (AUC), CRP was superior to PCT in detecting infectious complications, with an AUC of 0.82 for CRP versus an AUC of 0.69 for PCT. CONCLUSION: The pooled accuracy estimates of 6 different studies indicated only a moderate rule-out diagnostic value of both PCT and CRP in discriminating infection from other inflammatory complications following allogeneic HSCT.