| ObjectiveThe carbapenem resistance has become a prominent and hot issue with the long-term and extensive application of carbapenem antibiotics.The paper have a retrospective study of the incidence of blood flow infection,bacterial distribution,drug sensitivity,clinical characteristics and survival of the gram negative bacteria(Gram negative bacteria,G-bacteria)resistant to carbapenems in Department of Hematology so as to find the factors to lead to the blood flow infection and death.Then the medical man could adopt a better clinical rational selection of anti infective drugs to reduce the incidence of drug resistance and improve the prognosis of patients.Masterial and methodsThe clinical data of 443 cases of gram negative bacteria blood flow infection in the Department of Hematology of the First Affiliated Hospital of Zhengzhou University from April 2012 to March 2017 are considered as the research topic,which includes 47 cases of drug resistance and 396 cases in sensitive group.The distribution of carbapenem antibiotics,drug sensitivity,clinical characteristics and the survival of blood flow infection 30 days after challenging are analyzed.The clinical characteristics and survival of the patients in the drug resistant group were compared between the single factor and multifactor logistic regression in order to analyze the susceptibility factors and fatal causes.Results1.The positive rate of blood culture in patients with hematological diseases was 10.8% in the course of study,and 443 Gram-negative strains of carbapenems were detected which including 47 resistant strains,396 sensitive strains,and 10.6% carbapenems in Gram-negative bacteria(47/443).Through the data in the research,the incidence of carbapenems resistant strains and the trend of annual increase had increased from 9.1% in first years to 14.8% in fifth years.Escherichia coli(21.3%)and Klebsiella pneumoniae(21.3%)were the most common among the 47 carbapenem resistant gram-negative bacteria.2.The sensitivity of polymyxin B(95.7%)and tigocycline(90.5%)to Amikacin(58.1%)were maintained Among the 47 strains of carbapenem resistant G-bacteria.3.The mortality of 443 patients infected with hematological diseases is 27.3%.The mortality of carbapenem antibiotics resistant was 51.1% and sensitive group was 24.5%.The experimental data between the two groups had a statistical significance(P = 0.000).Single factor analysis showed that malignant hematopathy(90.9% vs.80.9%,P=0.031),pulmonary infection(72.3% vs.51%,P = 0.006),glucocorticoid treatment(53.2% vs.28.8%,P = 0.001),immunosuppressive therapy(44.7% vs.11.1%,P = 0.000)are found in the drug resistant group.The patients who had the history of antibiotic exposure before bloodstream infection(78.7% vs.50.3%,P = 0.000),especially carbapenems(59.6% vs.20.2%,P=0.000),3/4 generation cephalosporin(14.9% vs.6.1%,P = 0.025),piperacillin tazobactam(29.8% vs.8.6%,P = 0.000),aminoglycoside(27.7% vs.14.1%,P=0.016),cefoperazone sulba Tan(23.4% vs.11.4%,P=0.019)had more exposure history than the sensitive group,and the data was statistically significant.Multifactor Logistic regression analysis showed that hematology combined with pulmonary infection(OR 2.226,95%CI 1.055-4.694,P=0.036),and glucocorticoid treatment(OR 2.051,95%CI 1.011-4.159,P=0.046),immunosuppressive therapy(OR 4.845,95%CI 2.041-11.504,P=0.000),and carbapenems(OR 4.516,95%CI 1.777-11.474,P=0.002)30 days before bloodstream infection patients and piperacillin tazobactam(OR 2.965,95%CI 1.228-7.160,P=0.016)were independent risk factors to the occurrence of carbapenem resistant G--resistant bloodstream infection in hematology patients.4.The mortality rate of 47 cases of carbapenem resistant G-infection was 51.1%(24/47).Single factor analysis showed that the patients in the death group were combined with pulmonary infection(87.5% vs.56.5%,P = 0.018),blood culture in neutrophils deficiency(91.7% vs.60.9%,P = 0.013),septic shock(41.7% vs.8.7%,P = 0.010),antibiotic exposure time > 15 days(66.7% vs.34.8%,P = 0.029).The exposure history of antibiotics to carbapenem(83.3% vs.34.8%,P = 0.001)and aminoglycosides(45.8% vs.8.7%,P = 0.004),the heat peak in blood culture(> 39 C)(83.3% vs.56.5%,P = 0.045)and the initial unsuitable antiinfection treatment(70.8% vs.13%,P = 0.000)were all higher than those in the survival group,and the data was statistically significant.The results of multifactor analysis showed that infectious shock(OR 120.951,95%CI 1.363-10730.154,P=0.036),initial unsuitable antiinfection treatment(OR 35.020,95%CI 2.003-612.249,P=0.015),and the history of exposure to carbapenems(OR 81.942,95%CI 1.039-6464.803,P=0.048)were found in patients with hematology carbapenem resistant G-bacteria,and were independent risk factors.Conclusion1.The incidence of carbapenem resistant strains in hematology patients was increasing year by year,and dominated by Escherichia coli and Klebsiella pneumoniae.2.The use of corticosteroids and / or immunosuppressive agents,the exposure history of carbapenems and piperacillin and tazobactam 30 days before hematology combined with pulmonary infection and bloodstream infection were independent risk factors for the resistance of hematology to the bloodstream infection of carbapenems G-bacteria.3.The incidence of septic shock in patients with hematology carbapenems resistant G-bacteria,who had the inappropriate initial anti infection treatment and the history of exposure to carbapenems were independent risk factors for their death. |
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