高危血液病患者筛查和抗菌预防革兰氏阴性菌感染的当前做法:泛欧调查的结果。

IF 3.8 Q2 INFECTIOUS DISEASES Therapeutic Advances in Infectious Disease Pub Date : 2024-10-29 eCollection Date: 2024-01-01 DOI:10.1177/20499361241271863
Jannik Stemler, Eleni Gavriilaki, Oksana Hlukhareva, Nina Khanna, Dionysios Neofytos, Murat Akova, Livio Pagano, José-Miguel Cisneros, Oliver A Cornely, Jon Salmanton-García
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引用次数: 0

摘要

背景:细菌感染经常发生在血液病患者身上,尤其是在强化化疗后的长期中性粒细胞减少期间,通常会导致血流感染和肺炎:目的:针对高危血液病患者的常规抗菌药预防(AMP)仍存在争议,而全球多重耐药(MDR)革兰氏阴性菌(GNB)的流行率却在不断上升。我们旨在评估目前在这一人群中使用 AMP 的情况:横断面观察调查研究。方法:邀请欧洲范围内的血液科医生和传染病医生参与在线调查,调查内容包括革兰氏阴性菌的常规筛查、MDR-革兰氏阴性菌定植的发生率、抗菌药预防措施、血流感染(BSI)率、重症监护室入院率以及因革兰氏阴性菌和 MDR-GNB 感染而导致的死亡率:来自 28 个国家的 120 个血液学中心参加了此次研究。86.7%的中心对 MDR-GNB 进行了筛查,主要是通过直肠拭子(58.3%)。39.2%的中心常规使用 AMP,主要是氟喹诺酮类药物。在大肠杆菌(10% 对 7%)、克雷伯菌属(10% 对 5%)和假单胞菌属(5% 对 4%)方面,未接受抗 GNB 预防治疗的患者的 GNB-BSI 感染率高于接受预防治疗的患者。在对 MDR 大肠杆菌(5% vs 3%)、克雷白杆菌属(5% vs 3%)和假单胞菌属(2% vs 1%)使用 AMP 的中心,MDR-GNB 感染率估计较低。在一项探索性分析中,南欧和东欧国家的 MDR-GNB 感染率较高,而 ICU 入院率和死亡率较低,这可能存在估计偏差:结论:MDR-GNB 的筛查经常进行。结论:MDR-GNB 的筛查经常进行,针对 GNB 感染的 AMP 仍经常实施。估计的 BSI 感染率相当低,而 MDR-GNB 感染率却在上升。包括抗菌药物管理在内的定制预防措施变得更加重要。
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Current practice of screening and antimicrobial prophylaxis to prevent Gram-negative bacterial infection in high-risk haematology patients: results from a pan-European survey.

Background: Bacterial infections frequently occur in haematological patients, especially during prolonged neutropenia after intensive chemotherapy, often leading to bloodstream infections and pneumonia.

Objective: Routine antimicrobial prophylaxis (AMP) for high-risk haematology patients is still debated while prevalence of multi-drug resistant (MDR) Gram-negative bacteria (GNB) is rising globally. We aimed to assess the current practice of AMP in this population.

Design: Cross-sectional observational survey study.

Methods: Haematologists and infectious diseases physicians Europewide were invited to an online survey including questions on routine screening for GNB, incidence of MDR-GNB colonization, antimicrobial prophylaxis practices, rates of bloodstream infections (BSI), ICU admission and mortality differentiated by infections due to GNB versus MDR-GNB.

Results: 120 haematology centres from 28 countries participated. Screening for MDR-GNB is performed in 86.7% of centres, mostly via rectal swabs (58.3%). In 39.2% of routine AMP is used, mostly with fluoroquinolones. Estimates of GNB-BSI yielded higher rates in patients not receiving anti-GNB prophylaxis than in those who do for E. coli (10% vs 7%) Klebsiella spp. (10% vs 5%), and Pseudomonas spp. (5% vs 4%). Rates for MDR-GNB infection were estimated lower in centres that administer AMP for MDR E. coli (5% vs 3%) Klebsiella spp. (5% vs 3%), and Pseudomonas spp. (2% vs 1%). In an exploratory analysis, Southern and Eastern European countries expected higher rates of MDR-GNB infections with lower ICU admission and mortality rates which may be subject to estimation bias.

Conclusion: Screening for MDR-GNB is frequently performed. AMP against GNB infections is still often implemented. Estimated BSI rates are rather low, while the rate of MDR-GNB infections rises. Tailored prophylaxis including antimicrobial stewardship becomes more important.

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来源期刊
CiteScore
5.30
自引率
8.80%
发文量
64
审稿时长
9 weeks
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