恶性肿瘤患者ESKAPE病原菌血流感染临床特征和危险因素分析

  目的  屎肠球菌（Enterococcus faecium ）、金黄色葡萄球菌（Staphylococcus aureus ）、肺炎克雷伯菌（Klebsiella pneumoniae ）、鲍曼不动杆菌（Acinetobacter baumannii ）、铜绿假单胞菌（Pseudomonas aeruginosa ）以及肠杆菌属细菌（Enterobacter spp ）合称ESKAPE病原体。本研究探讨恶性肿瘤患者合并ESKAPE病原体血流感染的危险因素及死亡危险因素，为临床预防、诊断提供有效依据。  方法  收集2013?2018年就诊于四川省肿瘤医院的恶性肿瘤合并血流感染患者的临床资料和实验室数据，根据血培养分离所得病原菌分为ESKAPE血流感染组与非ESKAPE血流感染组，分析ESKAPE易感因素；以感染30 d患者是否存活，将ESKAPE血流感染组分为存活组和死亡组，分析死亡的危险因素。  结果  共计纳入753例患者，共分离出795株病原菌，其中ESKAPE病原菌278株，占全部分离菌的34.97%。分离出非ESKAPE病原菌的481例患者中，男性200例，女性281例。分离出ESKAPE病原菌的272例患者中，男性142例，女性130例。两组患者性别比差异有统计学意义。272例ESKAPE患者中47例失访，余下225例ESKAPE血流感染组患者中，死亡组27例，存活组198例，死亡率为12.00%（27/225）。单因素及多因素分析显示，男性患者、多种病原体感染、酶抑制剂类抗菌药物暴露史及中性粒细胞缺乏是恶性肿瘤患者发生ESKAPE病原菌血流感染的独立危险因素，而合并腹腔感染及真菌感染是其死亡的独立危险因素。  结论  对于恶性肿瘤患者，男性、多重感染、酶抑制剂类抗菌药物用药史、有中性粒细胞缺乏者应警惕ESKAPE病原体感染，若感染者存在真菌感染、腹腔感染，则应警惕死亡风险。

Clinical Characteristics and Risk Factors of ESKAPE Pathogens Bloodstream Infection in Cancer Patients

  Objective  To identify the risk factors of ESKAPE pathogens infection and related death in cancer patients, and to supply evidence for clinical precaution and diagnosis.  Methods  A retrospective study of clinical and experimental data of cancer patients with bloodstream infection were carried out in Sichuan Cancer Hospital from 2013 to 2018. The clinical feature, predisposing factors and risk factors of death in ESKAPE group and non-ESKAPE group were analyzed by univariate analysis and multivariate logistic regression.  Results  A total of 753 patients were enrolled in the study. Totally 795 pathogenic bacteria strains were isolated from blood culture and there were 278 ESKAPE strains, which took up 34.97% of isolated strains. Univariate analysis and multivariate logistic regression analysis showed that gender of male, multiple pathogens, history of exposure to enzyme inhibitors and agranulocytosis were independent risk factors of ESKAPE pathogens bloodstream infection. Peritoneal infection and combined fungal infection were independent risk factors of ESKAPE bloodstream infection related death.  Conclusion  The bloodstream infection of ESKAPE pathogens is a problem worthy of clinical attention for cancer patients with neutrophil deficiency, previous antibiotic exposure, and fungal infection and peritoneal infection.