| Objective: The aim of this study was to investigate the pathogenic epidemiology and antibiotic resistance of bloodstream infections(BSIs)in patients with hematologic malignancies(HMs)receiving chemotherapy,to explore the predictive value of procalcitonin(PCT)in BSIs,and to determine the risk factors for BSIs.Methods: From 2013.01 to 2016.12,3014 patients with hematological malignancy receiving chemotherapy in the general ward of hematology department of our hospital were included in the retrospective analysis study,including 725 cases of bloodstream infections(positive group)and 2089 cases of no bloodstream infections(negative group).The prognosis and survival of the patients were followed up to 30 days after blood culture.The distribution and drug resistance of pathogenic bacteria isolated from blood culture of patients with bloodstream infections were collected and analyzed.Receiver operating characteristic(ROC)curve analysis and calculation of the area under the curve(AUC)were performed to determine the diagnostic utility of various cutoffs.Youden's indices(sensitivity + specificity-1)were calculated to determine the optimal discriminatory cutoff value.Logistic and COX regression analysis were used to analyze the risk factors of incidence and prognosis of patients with hematological malignancy receiving chemotherapy.Results: 1 BSIs frequency was 24.1%,with 744 different isolated strains in 725 cases.Bacteria were Gram-negative(G-)in 481 cases(64.7%)and Gram-positive(G+)in 206(27.7%)The most common isolates were Klebsiella pneumoniae(19.2%),Escherichia coli(16.4%),Coagulase-negative Staphylococci(Co NS)(14.8%)and Pseudomonas aeruginosa(14.5%).2 The rate of extended-spectrum beta-lactamases(ESBL)-producing Klebsiella pneumoniae and Escherichia coli was 22.63% and 60%,respectively,and up to 90% of ESBL-producing enterobacteria were multidrug-resistant(MDR).Pseudomonas aeruginosa resistance rate to Aminoglycoside and Fluoroquinolone was less than 3.0%,but was 14.0 % and 11.6% to Imipenem and Meropenem,respectively.Acinetobacter baumannii resistance to various antimicrobial agents was high.Methicillin-resistant Coagulase-negative Staphylococci(MRCNS)and Methicillin-resistant Staphylococcus aureus(MRSA)accounted for 87.16% and 37.93% of the cases,respectively,but Linezolid-,Teicoplanin-and Vancomycin-resistant strains were not detected.3 The median PCT levels were significantly higher for G-BSIs(0.72 ng/m L)than those for G+ BSIs(0.34 ng/m L)or fungal BCs(0.27 ng/m L).The best cut off value of PCT diagnostic accuracy in predicting bacteremia or Gram-negative BSIs is 0.56ng/m L.4 Multivariate analysis revealed that male,65 years > age ? 45 years,hospital length of stay(LOS)? 9 days,duration of neutropenia prior to BSIs ? 7 days,treatment with ? 2 antibiotics,complicated by gastrointestinal,perirectal and urinary tract infections are independently predicted emergence of BSIs.5 Multivariate analysis revealed that age ? 65 years,neutropenia for ? 7d before BSIs,no HM remission,lower white blood cell count,treatment with ? 3 antibiotics,respiratory infections,BSIs with Acinetobacter baumannii and Stenotrophomonas maltophilia were independent predictors of 30-day mortality.Conclusion: Outcome was poor and mortality due to BSIs was high in patients with HMs receiving chemotherapy.PCT could be a effective marker for diagnose of BSIs in future.Pathogens of BSIs were mainly G-,and were highly antibiotic-resistant.Thus,in this patient population,close attention should be paid to the risk factors identified here. |
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