Introduction
Materials and methods
Data collection
Strain identification and antimicrobial sensitivities
Definitions
Statistical analyses
Results
Clinical characteristics of the enrolled patients
Characteristics | Total (n = 63) | Survival (n = 53) | Non-survival (n = 10) | P value |
---|---|---|---|---|
Median age (range) | 31 (4–63) | 33 (7–63) | 27 (4–57) | 0.809 |
Male | 40 (63.5) | 32 (60.4) | 8 (80.0) | 0.302 |
Underlying diseases | 0.327 | |||
Acute myeloid leukemia | 34 (54.0) | 30 (56.6) | 4 (40.0) | |
Acute lymphoblastic leukemia | 17 (27.0) | 15 (28.3) | 2 (20.0) | |
Severe aplastic anemia | 9 (14.3) | 6 (11.3) | 3 (30.0) | |
Myelodysplastic syndromes | 2 (3.2) | 1 (1.9) | 1 (10.0) | |
Acute heterozygosis leukemia | 1 (1.6) | 1 (1.9) | 0 (0.0) | |
Status of acute leukemia | 0.397 | |||
Complete remission | 28 (53.8) | 26 (56.5) | 2 (33.3) | |
Treatment | 0.139 | |||
HSCT | 4 (6.3) | 4 (7.5) | 0 (0.0) | |
Chemotherapy | 48 (76.2) | 42 (79.2) | 6 (60.0) | |
Immunosuppressive therapy | 7 (11.1) | 5 (9.4) | 2 (20.0) | |
Neutropenic | ||||
Neutropenia at the onset of BSI | 57 (91.9) | 47 (90.4) | 10 (100.0) | 0.582 |
Severe neutropenia at the onset of BSI | 45 (72.6) | 37 (71.2) | 8 (80.0) | 0.713 |
Length of days for neutropenia before BSI, median (range) | 4 (0–21) | 4 (0–21) | 8 (0–16) | 0.083 |
Length of days for neutropenia after BSI, median (range) | 6 (2–39) | 7 (2–39) | 5.5 (2–22) | 0.82 |
Unresolved neutropenic | 18 (29.0) | 9 (17.3) | 9 (90.0) |
< 0.001
|
Hospital-acquired | 57 (90.5) | 49 (92.5) | 8 (80.0) | 0.24 |
Clinical presentation | ||||
Fever | 63 (100.0) | 53 (100.0) | 10 (100.0) | – |
Shock | 8 (12.7) | 1
(1.9) | 7 (70.0) |
< 0.001
|
Gastroenteritis | 12 (19.0) | 10 (18.9) | 2 (20.0) | 1 |
Skin and soft tissue infection | 14 (22.2) | 7 (13.2) | 7 (70.0) |
0.001
|
Mucositis | 7(11.1) | 5 (9.4) | 2 (20.0) | 0.306 |
Pneumonia | 9 (14.3) | 7 (13.2) | 2 (20.0) | 0.626 |
Antimicrobial exposure within 30 days | 21 (33.3) | 16 (30.2) | 5 (50.0) | 0.28 |
Clinical characteristics and 30-day outcomes of patients with SSTI concomitant infections
Sex | Age | Underlying condition | CR | ANC (109/L) | Duration of neutropenia (Days) | Clinical presentation | Sites of involvement | Necrotizing SSTI | Shock | Pathogen | CR-Aeromonas | CA or HA | Empirical therapy | Appropriate initial empirical treatment | Outcomes | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | M | 4 | AA | NA | 0.21 | 24 | Persistent groin pain | Groin | N | N |
Aeromonas sobria
| Y | CA | CAZ, SMZ | N | Death |
2 | F | 6 | ALL | N | 0.01 | 18 | Serve pain, skin bullae and necrosis | Lower limbs and perineum | Y | Y |
Aeromonas sobria
| N | HA | MEM | Y | Death |
3 | M | 21 | MDS | N | 0 | 10 | Serve pain, muscle swelling and necrosis | Lower limbs | Y | N |
Aeromonas hydrophila
| Y | CA | IPM | N | Death |
4 | M | 12 | ALL | N | 0.03 | 12 | Serve pain, muscle swelling and necrosis | Lower limbs and buttocks | Y | N |
Aeromonas hydrophila
| Y | HA | MEM | N | Amputation |
5 | M | 13 | AA | NA | 0 | 4 | Red papules and firm nodules in skin with pain | The four limbs | N | N |
Aeromonas hydrophila
| Y | HA | SCF | Y | Survival |
6 | M | 27 | AML | CR | 0.05 | 7 | Unilateral lower limb pain and muscle swelling | Unilateral lower limb | N | N |
Aeromonas hydrophila
| Y | HA | IPM | N | Survival |
7 | M | 27 | AA | NA | 0.07 | 15 | Serve pain, ecchymoses, necrosis | Starts at the knees and ankles then spreads throughout the body | Y | Y |
Aeromonas sobria
| Y | HA | IPM | N | Death |
8 | M | 51 | ALL | N | 0 | 10 | Skin swelling, bullae formation and necrosis | Lower limbs, abdomen and perineum | Y | Y |
Aeromonas hydrophila
| Y | HA | MEM、IPM | N | Death |
9 | M | 54 | AA | NA | 0.03 | 18 | Rhabdomyolysis: muscle pain, weakness, and dark urine | Muscles and multiple organs | Y | Y |
Aeromonas hydrophila
| Y | HA | MEM | N | Death |
10 | M | 63 | AA | NA | 0.28 | 24 | Muscle pain and swelling | Lower limbs | N | N |
Aeromonas sobria
| Y | HA | IPM | N | Survival |
11 | M | 30 | AML | N | 0.27 | 21 | Muscle pain | Lower limbs | N | N |
Aeromonas hydrophila
| NA | HA | MEM | NA | Survival |
12 | M | 30 | ALL | N | 0.04 | 22 | Balanoposthitis | Genitals | N | N |
Aeromonas hydrophila
| NA | HA | MEM | NA | Survival |
13 | M | 11 | ALL | N | 0.01 | 18 | Subcutaneous abscess on the left abdomen | Abdomen | N | N |
Aeromonas hydrophila
| NA | HA | SCF, MEM | NA | Survival |
14 | M | 27 | AML | CR | 0 | 41 | Skin swelling, bullae formation and necrosis | The four limbs | Y | Y |
Aeromonas sobria
| NA | HA | IPM, TZP, CIP | NA | Death |
Antibiotic resistance and resistance transformation
Antimicrobial agent | Resistant rate (n) | Breakpoints | |
---|---|---|---|
S | R | ||
Aztreonam | 8.2 (49) | ≤ 4 | ≥ 16 |
Cefuroxime | 8.2 (49) | ≤ 8 | ≥ 32 |
Ceftriaxone | 8.2 (49) | ≤ 1 | ≥ 4 |
Ceftazidime | 6.1 (49) | ≤ 4 | ≥ 16 |
Cefepime | 0.0 (49) | ≤ 8 | ≥ 32 |
Piperacillin/tazobactam | 32.7 (49) | ≤ 16/4 | ≥ 128 /4 |
Meropenem | 71.4 (49) | ≤ 1 | ≥ 4 |
Imipenem | 70.8 (48) | ≤ 1 | ≥ 4 |
Ciprofloxacin | 4.1 (49) | ≤ 1 | ≥ 4 |
Levofoxacin | 2.1 (48) | ≤ 2 | ≥ 8 |
Gentamicin | 4.1 (49) | ≤ 4 | ≥ 16 |
Amikacin | 0.0 (49) | ≤ 16 | ≥ 64 |
Tegacycline | 0.0 (40) | ≤ 2 | ≥ 8 |
Trimethoprim/Sulfamethoxazole | 22.5 (49) | ≤ 2/38 | ≥ 4/76 |
Pathogen | Antibiotic treatment | Time interval | MICs (the 1st isolate-the final isolate) | Outcomes | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
FEP | TZP | MEM | IPM | CIP | LVX | GEN | TGC | |||||
Case 1 |
Aeromonas sobria
| CAZ, ET, SMZ, TGC, FEP, IPM, CIP | 19 |
< 1–64
| < 4 | > 16 | < 1 |
1–>4
|
1–>8
| > 16 | NA | Death |
Case 2 |
Aeromonas sobria
| IPM, AK, SCF, MEM | 2 | < 1 |
< 4–128
|
< 0.25–>16
| < 1–4 | 1 | 1 | 2 | NA | Survival |
Case 3 |
Aeromonas hydrophila
| SCF, CIP, IPM, ET | 7 | < 1 | > 128 | > 16 | > 16 |
1–>4
| 1 | < 1 | 1 | Survival |
Case 4 |
Aeromonas hydrophila
| MEM, ET, LVX, CRO | 8 | < 1 | > 128 | > 16 | 8 |
1–>4
|
1–>8
| < 1 |
1–>8
| Amputation |
Case 5 |
Aeromonas sobria
| MEM, TGC, SCF | 6 | 2 | > 128 | > 16 | > 16 | > 4 |
2–>8
| < 1 |
1–>8
| Survival |
Time distribution of infection
Outcome analysis for non-survivors
Item | Univariate logistic regression | Multivariate logistic regression | ||||
---|---|---|---|---|---|---|
OR | 95% CI |
P value | OR | 95% CI | P value | |
Male | 2.348 | 0.423–13.047 | 0.329 | / | / | / |
Age | 0.999 | 0.958–1.042 | 0.96 | / | / | / |
ANC at the onset of BSI | 6.414 | 0.019-2130.026 | 0.53 | / | / | / |
Unresolved neutropenic
|
21.7
|
2.373–198.447
|
0.006
| 14.003 | 0.799-245.273 | 0.071 |
Shock
|
66.667
|
5.772–770.001
|
0.001
|
47.575
|
1.064-2126.803
|
0.046
|
Gastroenteritis | 0.833 | 0.086–8.044 | 0.875 | / | / | / |
Skin and soft tissue infection
|
27.75
|
4.134–186.274
|
0.001
|
28.716
|
1.496–551.300
|
0.026
|
Appropriate empirical treatment | 0.192 | 0.034–1.076 | 0.061 | / | / | / |
Antimicrobial exposure | 2.727 | 0.580-12.831 | 0.204 | / | / | / |