Objective: To investigate the distribution and clinical characteristics of pathogenic bacteria following hematopoietic stem cell transplantation (HSCT), as well as to provide a preliminary research foundation for key microbial monitoring, and clinical diagnosis and treatment of infections after HSCT in hematological patients. Methods: We retrospectively analyzed the clinical data of 190 patients who tested positive for microbial testing [G-bacteria blood culture and/or carbapenem-resistant organism (CRO) screening of perianal swabs] at our center from January 2018 to December 2022. Patients were divided into blood culture positive, perianal swab positive, and double positive groups based on the testing results. The three patient groups underwent statistical analysis and comparison. Results: The top four pathogenic bacteria isolated from sixty-three patients with G-bacteria bloodstream infection (BSI) were Escherichia coli (28 strains, 43.75% ), Klebsiella pneumonia (26 strains, 40.63% ), Pseudomonas aeruginosa (3 strains, 4.69% ), and Enterobacter cloacae (3 strains, 4.69% ). The top three pathogenic bacteria isolated from 147 patients with CRO perianal colonization were carbapenem-resistant Klebsiella pneumoniae (58 strains, 32.58% ), carbapenem-resistant Escherichia coli (49 strains, 27.53% ), and carbapenem-resistant Enterobacter cloacae (20 strains, 11.24% ). The 3-year disease-free survival (DFS ) and overall survival (OS) of double positive group patients were significantly lower compared to those in the blood culture and perianal swab positive groups (DFS: 35.6% vs 53.7% vs 68.6%, P=0.001; OS: 44.4% vs 62.4% vs 76.9%, P<0.001), while non-relapse mortality (NRM) was significantly higher (50.0% vs 34.9% vs 10.6%, P<0.001). Failed engraftment of platelets and BSI are independent risk factors for NRM (P<0.001). Using polymyxin and/or ceftazidime-avibactam for more than 7 days is an independent protective factor for NRM (P=0.035) . Conclusion: This study suggests that the occurrence of BSI significantly increases the NRM after HSCT in patients with hematological diseases; CRO colonization into the bloodstream has a significant impact on the DFS and OS of HSCT patients.
目的： 探讨造血干细胞移植（HSCT）后感染和定植的病原菌分布及临床特征，以期为血液病患者移植后并发感染的重点菌群监测与临床诊疗提供初步研究依据。 方法： 回顾性分析2018年1月至2022年12月华中科技大学同济医学院附属协和医院血液科190例微生物检测[革兰阴性菌（G(-)菌）血培养和/或肛拭子耐碳青霉烯类革兰阴性菌（CRO）筛查]阳性患者的临床资料，根据患者检测结果分为血培阳组、肛拭阳组、双阳组。统计分析比较三组患者情况。 结果： 63例发生G(-)菌血流感染（BSI）的患者分离病原菌排名前四位的为大肠埃希菌（28株，43.75%）、肺炎克雷伯菌（26株，40.63%）、铜绿假单胞菌（3株，4.69%）和阴沟肠杆菌（3株，4.69%）。147例发生CRO肛周定植的患者分离病原菌排名前三位的为耐碳青霉烯肺炎克雷伯菌（58株，32.58%）、耐碳青霉烯大肠埃希菌（49株，27.53%）、耐碳青霉烯阴沟肠杆菌（20株，11.24%）。双阳组患者的3年无病生存（DFS）率和总生存（OS）率与血培阳组和肛拭阳组相比显著降低（DFS：35.6%对53.7%对68.6%，P＝0.001；OS：44.4%对62.4%对76.9%，P<0.001），非复发死亡率（NRM）显著增高（50.0%对34.9%对10.6%，P<0.001）。血小板未植入和发生BSI为NRM的独立危险因素（P<0.001）。加用多黏菌素和（或）头孢他啶阿维巴坦后使用天数>7 d为NRM的独立保护因素（P＝0.035）。 结论： 发生BSI会显著增加血液病患者HSCT后的NRM；CRO定植加入血会严重影响其DFS和OS。.
Keywords: Bloodstream infection; Carbapenem-resistant Enterobacteriaceae; Carbapenem-resistant organism; Hematopoietic stem cell transplantation; Perianal colonization.