ABSTRACT
Objective:To analyze the clinical characteristics and the risk factors for poor prognosis of patients with bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP), and to guide clinical treatment. Methods:The clinical characteristics, co-infection sites, comorbidities, laboratory tests, and antimicrobial drug exposure of adult patients with CRKP BSI admitted to The First Affiliated Hospital of Anhui Medical University from August 2015 to August 2020 were retrospectively analyzed. The patients were divided into good prognosis group and poor prognosis group. The clinical data of the two groups were compared. Statistical analysis was performed using Mann-Whitney U test and chi-square test. Binary logistic regression was used to analyze the risk factors for poor prognosis in patients with CRKP BSI. Results:Among the 106 CRKP BSI patients, 47 were in the good prognosis group and 59 were in the poor prognosis group. The length of hospital stay (39(22, 89) d vs 21(15, 38) d), the ratio of history of admission within 90 days (17.0%(8/47) vs 35.6%(21/59)), the ratio of history of carbapenems exposure (42.6%(20/47) vs 64.4%(38/59)), the ratio of complicated with lower respiratory tract infection (44.7%(21/47) vs 78.0%(46/59)), the ratio of admission to intensive care unit (34.0%(16/47) vs 81.4%(48/59)), the ratio of septic shock (19.1%(9/47) vs 69.5%(41/59)), the ratio of complicated with multiple organ dysfunction syndrome (MODS) (10.6%(5/47) vs 74.6%(44/59)), the ratio of solid organ transplantation status (40.4%(19/47) vs 18.6%(11/59)), the ratio of surgery (51.1%(24/47) vs 32.2%(19/59)), the ratio of mechanical ventilation (23.4%(11/47) vs 74.6%(44/59)), the Pitt bacteremia scores ≥4 points (21.3%(10/47) vs 69.5%(41/59)), the quick sequential organ failure assessment (qSOFA) scores ≥2 points (14.9%(7/47) vs 81.4%(48/59)), the ratio of platelets counts<100×10 9/L (31.9%(15/47) vs 62.7%(37/59)) had statistical differences between the poor prognosis group and the good prognosis group ( Z=-3.72, χ2=4.54, 5.04, 12.46, 24.48, 26.61, 43.02, 6.12, 3.86, 27.44, 24.36, 46.29 and 9.93, respectively; all P<0.050). Multivariate analysis showed that BSI complicated with lower respiratory tract infection (odds ratio ( OR)=3.293, 95% confidence interval ( CI) 1.138 to 9.528, P=0.028) and MODS ( OR=21.750, 95% CI 7.079 to 66.829, P<0.001) were independent risk factors for poor prognosis of CRKP BSI. Conclusions:Patients with CRKP BSI complicated with lower respiratory tract infection are more likely to have a poor prognosis. Timely maintenance of organ function may improve the prognosis of CRKP BSI.
ABSTRACT
Objective:To analyze the difference of immune damage between patients with severe fever with thrombocytopenia syndrome (SFTS) and patients with tsutsugamushi disease.Methods:A prospective case-control study was conducted. Thirty-one patients with SFTS and 16 patients with tsutsugamushi disease admitted to the First Affiliated Hospital of Anhui Medical University from October 2014 to June 2017 were enrolled, and another 10 healthy people were enrolled as control. The counts of CD4 + and CD8 + T lymphocytes, and the proportion of CD3 + T lymphocytes, natural kill cells (NK cells), B lymphocytes and plasma cells were detected by flow cytometry. Thirty-four inflammatory mediators were determined by a multiplex Luminex? system synchronously. The differences of lymphocytes and cytokines between the two groups were compared. Results:The proportion of CD3 + T lymphocytes, the counts of CD4 + and CD8 + T lymphocytes in SFTS patients were significantly lower than those in patients with tsutsugamushi disease ( t values were 4.860, 9.411 and 5.030, respectively, all P < 0.01), and the proportion of NK cells and B lymphocytes were significantly higher than those in patients with tsutsugamushi disease ( t values were 2.344 and 5.896, respectively, both P < 0.05). The proportion of plasma cells in peripheral blood of SFTS patients was (7.7±1.2)%, the highest proportion of plasma cells in severe SFTS patients was up to 30%, and all patients showed λ monoclonal cell group in plasma cells. No plasma cells were detected in tsutsugamushi disease patients. The abnormal expressions of interleukin-1 receptor antibody (IL-1RA), interleukin (IL-6, IL-15, IL-10, IL-8), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), granulocyte colony-stimulating factor (G-CSF), eosinophil chemotactic factor (Eotaxin), IFN-γ-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein (MIP-1α, MIP-1β), platelet-derived growth factor (PDGF-AA, PDGF-AB/BB), activated regulatory normal T cells and secretion factors (RANTES) were found in patients with SFTS and tsutsugamushi disease. The levels of IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, Eotaxin, IL-8, IP-10, MCP-1 and MIP-1α in SFTS patients were significantly higher than those in patients with tsutsugamushi disease ( Z values were 2.312, 2.447, 3.660, 5.444, 1.965, 2.402, 2.402, 2.997, 3.525, 2.481, 3.817, and 2.211, respectively, all P < 0.05), while PDGF-AA, PDGF-AB/BB and RANTES were significantly lower than those in patients with tsutsugamushi disease ( Z values were 3.728, 2.514, 2.649, respectively, all P < 0.05). Correlation analysis showed that RANTES, PDGF-AA and PDGF-AB/BB levels were significantly positively correlated with the level of platelet in patients with SFTS and tsutsugamushi disease (SFTS: r values were 0.223, 0.365, 0.330; tsutsugamushi disease: r values were 0.263, 0.632, 0.407, respectively, all P < 0.05). In SFTS patients, compared with the survival group ( n = 21), the CD3 + and CD4 + T lymphocytes in the death group ( n = 10) significantly decreased, while the plasma cells significantly increased ( t values were 3.980, 3.314 and 26.692, respectively, all P < 0.01); IL-1RA, IL-6, IL-15, IL-10, TNF-α, IFN-γ, G-CSF, Eotaxin, IL-8, IP-10, MCP-1, MIP-1α and MIP-1β significantly increased, while PDGF-AA, PDGF-AB/BB and RANTES significantly decreased ( Z values were 3.930, 4.014, 2.832, 3.592, 2.958, 3.508, 2.578, 3.254, 4.270, 3.465, 2.663, 3.085, 3.107, 3.639, 3.043 and 3.825, respectively, all P < 0.05). Conclusions:The immune function was impaired more seriously in SFTS patients than that in tsutsugamushi disease patients. Excessive humoral immunity and apoptosis of T lymphocytes are closely related to the death in SFTS patients. The detection of CD4 cells, plasma cells and proinflammatory and anti-inflammatory cytokines (e.g. IL-6, IL-10) had great clinical significance for the differentiation and illness evaluation in disease with SFTS or tsutsugamushi disease.