bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2016-61-1-25-32bloodjour-10Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДетекция энтеробактерий с продукцией бета-лактамаз расширенного спектра у больных острыми миелоидными лейкозами и лимфомами при поступлении в стационарDetection of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) among patients with acute myeloid leukemia and lymphoma upon admission to hospitalhttps://orcid.org/0000-0001-5973-5763КлясоваГ. А.KlyasovaG. A.

Клясова Галина Александровна - доктор медицинских наук, профессор, заведующая научно-клинической лабораторией клинической бактериологии, микологии и антибиотической терапии

ResearcherID: M-6329-2014

125167, г. Москва

Galina A. Klyasova, MD, PhD, Prof., head of scientifc clinical laboratory of clinical bacteriology, mycology and antibiotic therapy

ResearcherID: M-6329-2014

Moscow, 125167

 

klyasova.g@blood.ruhttps://orcid.org/0000-0002-6268-5282КоробоваА. Г.KorobovaA. G.

Researcher ID: M-6469-2014

125167, г. Москва

Researcher ID: M-6469-2014

Moscow, 125167

https://orcid.org/0000-0001-9308-9259ФроловаИ. Н.FrolovaI. N.

Researcher ID: M-7110-2014

125167, г. Москва

Researcher ID: M-7110-2014

Moscow, 125167

https://orcid.org/0000-0002-6195-4508ОхматВ. А.OkhmatV. A.

Researcher ID: M-7089-2014

125167, г. Москва

Researcher ID: M-7089-2014

Moscow, 125167

КуликовС. М.KulikovS. M.

Researcher ID: P-8020-2014

125167, г. Москва

Researcher ID: P-8020-2014

Moscow, 125167

https://orcid.org/0000-0001-6177-3566ПаровичниковаЕ. Н.ParovichnikovaE. N.

125167, г. Москва

Moscow, 125167

КравченкоС. К.KravchenkoS. K.

125167, г. Москва

Moscow, 125167

ФГБУ «Гематологический научный центр» Минздрава РоссииРоссияNational Research Center for HematologyRussian Federation2016250220196112532Copyright © Клясова Г.А., Коробова А.Г., Фролова И.Н., Охмат В.А., Куликов С.М., Паровичникова Е.Н., Кравченко С.К., 20192019Клясова Г.А., Коробова А.Г., Фролова И.Н., Охмат В.А., Куликов С.М., Паровичникова Е.Н., Кравченко С.К.Klyasova G.A., Korobova A.G., Frolova I.N., Okhmat V.A., Kulikov S.M., Parovichnikova E.N., Kravchenko S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/10

Цель работы – изучить колонизацию слизистой оболочки кишечника и ротоглотки энтеробактериями с продукцией бета-лактамаз расширенного спектра (БЛРС) у больных острыми миелоидными лейкозами (ОМЛ) и лимфомами до курса химиотерапии. В проспективное исследование (2013–2014 гг.) были включены 98 больных (33 ОМЛ и 65 лимфомами), из них у 94 (96%) гемобластоз был диагностирован впервые. Медиана возраста больных лимфомами составила 47 лет, ОМЛ – 35 лет. У больных мазки со слизистой оболочки ротоглотки и прямой кишки брали в первые 2 дня госпитализации в Гематологическом научном центре (ГНЦ, Москва) для выявления энтеробактерий с продукцией БЛРС. Для детекции БЛРС использовали фенотипические методы для детекции генов резистентности blaTEMи blaCTX-M – метод полимеразной цепной реакции (ПЦР). При поступлении колонизацию слизистой оболочки кишечника энтеробактериями с продукцией БЛРС выявили у 26 (27%) больных (у 28% лимфомами, у 24% ОМЛ) и лишь у 4 (4%) – со слизистой ротоглотки; p < 0,01. Было выделено 34 изолята (E. coli 52%, K. pneumoniae 42%, Citrobacter spp. 6%). Бета-лактамазы CTX-M типа были у 76% изолятов, TEM типа – у 53%, одновременно два типа – у 44%. У больных лимфомами статистически значимыми факторами колонизации продуцентами БЛРС были перевод в ГНЦ из другого стационара (ОШ 4,2; p = 0,01), возраст от 50 лет и старше (ОШ 3,0; p = 0,05), у больных ОМЛ – проживание не в Москве (ОШ 7,6; p = 0,04). При многофакторном анализе независимыми оказались те же факторы. Полученные результаты ставят под сомнение назначение фторхинолонов для профилактики без предварительного обследования.Профилактическое назначение фторхинолона будет оптимальным только для больных без колонизации кишечника энтеробактериями с продукцией БЛРС.

The aim of the study was to evaluate colonization with ESBL-E of gut and oropharynx in patients with acute myeloid leukemia (AML) and lymphoma before the start of the chemotherapy. 98 patients (33 with AML and 65 with lymphoma) were included in the prospective study (2013–2014). Newly diagnosed hematological malignancies were in 94 (96%) patients. Median age of patients with lymphoma and AML was 47 and 35 years. For the first two days after admission to the hospital swabs from gut and oropharynx in patients were taken. ESBL production was confirmed by phenotypic tests, the genes blaCTX-M and blaTEM - by real-time PCR. Upon admission to the hospital ESBL-E colonization of gut was detected in 27% patients (28% in AML and 24% in lymphoma) and only 4% patients had ESBL-E colonization of throat, p < 0,01. Total of 34 of ESBL-E isolates were detected (E. coli 52%, K. pneumonia 42%, Citrobacter spp. 6%). CTX-M type ESBL was detected in 76% of isolates, TEM type – in 53%, coexistence of TEM and CTX-M – in 44%. Independent risk factors for ESBL-E colonization in patients with lymphoma were transfer from another hospital (OR 4,2; p = 0,01) and age from 50 years and older (OR 3,0; p = 0.05); in patients with AML – place of living outside of Moscow (OR 7,6; p = 0,04). Multivariate analysis showed the same risk factors. Our results make doubtful the prescription of fluoroquinolones for prophylaxis without prior screening. Prophylaxis with fluoroquinolones may be optimal only for patients without ESBL-E colonization.

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The authors declare that there are no conflicts of interest present.