Objectives: This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors. Methods: This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed. Results: A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% vs 36.2%, P<0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% vs 33.3%, P=0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% vs 34.1%, P=0.012; 24 h: 40.8% vs 65.9%, P=0.008). Multivariate analysis revealed that septic shock (HR=24.436, 95% CI 4.148 - 143.966, P<0.001) and pulmonary infection (HR=9.346, 95% CI 2.718-32.140, P<0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h (HR=0.225, 95% CI 0.059 - 0.851, P=0.028), and treatment with the ceftazidime-avibactam-containing regimen (HR=0.082, 95% CI 0.018-0.362, P=0.001) significantly reduced mortality. Conclusion: The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.
目的： 分析血液病患者合并耐碳青霉烯类肠杆菌科细菌（CRE）血流感染的临床及分子学特征，探讨预后危险因素。 方法： 对中国医学科学院血液病医院2015年1月至2022年12月发生CRE血流感染的血液病患者进行回顾性研究，分析临床特点、碳青霉烯酶检测结果、抗感染治疗及转归。 结果： 共120例患者发生CRE血流感染。大肠埃希菌最多见（58/120，48.3%），其次为肺炎克雷伯菌（52/120，43.3%）。93株CRE进行了碳青霉烯酶检测，其中产碳青霉烯酶CRE共75株（金属酶51株、丝氨酸酶24株）。患者感染后30 d死亡率为24.2%（29/120）。单因素分析显示，接受含头孢他啶-阿维巴坦治疗患者的死亡率明显低于接受其他抗菌药物治疗患者（7.8%对36.2%，P<0.001）。此外，在感染发生24 h内接受有效抗感染治疗可显著降低死亡率（15.0%对33.3%，P=0.019）。而合并CRE定植患者，在12 h、24 h内接受有效抗感染治疗的比例明显高于无定植患者（12 h：34.1%对14.5%，P=0.012；24 h：65.9%对40.8%，P=0.008）。多因素分析发现，合并感染性休克（HR=24.436，95% CI 4.148~143.966，P<0.001）和肺感染（HR=9.346，95% CI 2.718~32.140，P<0.001）是患者30 d内死亡的独立危险因素。而24 h内接受有效抗感染治疗（HR=0.225，95% CI 0.059~0.851，P=0.028）以及接受含头孢他啶-阿维巴坦的治疗（HR=0.082，95% CI 0.018~0.362，P=0.001）可显著降低死亡率。 结论： 血液病患者合并CRE血流感染预后差，及早启动有效抗感染治疗以及应用含头孢他啶-阿维巴坦的方案可提高生存率、改善预后。.
Keywords: Bloodstream infection; Carbapenem-resistant Enterobacteriaceae; Hematologic disease.