恶性血液病患者合并血流感染的临床和病原学特征

发布时间：2018-07-28 13:14

【摘要】：目的探讨恶性血液病合并血流感染的病原学及临床特征,指导临床治疗。方法分析北京大学第三医院血液科2011年9月至2016年9月血培养阳性的恶性血液病合并血流感染患者的临床表现、治疗及预后,并对分离细菌进行鉴定及耐药分析。结果 92例患者中64.1%发生血流感染时为粒细胞缺乏,所有患者均有发热,45.7%发生感染中毒性休克,82.6%检测到降钙素原升高。检出107株病原体,其中革兰阴性菌75株(70.1%),革兰阳性菌27株(25.2%),真菌5株(4.7%)。药敏显示:大肠埃希菌对头孢曲松和左氧氟沙星耐药率最高,达80.9%和91.3%;肺炎克雷伯菌和鲍曼不动杆菌对亚胺培南有较高的耐药率,分别为31.2%和50.0%;革兰阳性菌对万古霉素及利奈唑胺尚敏感。92例患者死亡35例(38.0%),初始经验治疗抗生素是否有作用对预后有显著影响(P0.05),经验治疗采用碳青霉烯类抗生素组的病死率略低于非碳青霉烯类治疗组(28.6%对46.2%),但差异无统计学意义(P=0.163)。结论恶性血液病患者合并血流感染预后较差,致病原以革兰阴性菌为主,耐药发生率较高,对碳青霉烯类抗生素的耐药性应引起关注。初始经验治疗的有效性可显著影响预后。
[Abstract]:Objective to investigate the etiology and clinical features of malignant hematopathy complicated with blood stream infection and to guide clinical treatment. Methods from September 2011 to September 2016, the clinical manifestations, treatment and prognosis of patients with hematologic malignancy complicated with hematological infection were analyzed. The isolated bacteria were identified and drug resistance was analyzed. Results granulocyte deficiency was found in 64.1% of the 92 patients. 45.7% of the patients had fever and 45.7% of the patients had toxic shock and 82.6% had increased procalcitonin. Among the 107 pathogens, 75 (70.1%) were Gram-negative bacteria, 27 (25.2%) Gram-positive bacteria and 5 (4.7%) fungi. The susceptibility of Escherichia coli to ceftriaxone and levofloxacin was 80.9% and 91.3%, and Klebsiella pneumoniae and Acinetobacter baumannii had high resistance to imipenem. Gram-positive bacteria were sensitive to vancomycin and linazolamide in 35 patients (38.0%). The effect of initial experience therapy on the prognosis was significant (P0.05), and carbapenem antibiotics were used in empirical therapy. The fatality rate in group A was slightly lower than that in group B (28.6% vs 46.2%), but the difference was not statistically significant (P = 0.163). Conclusion the prognosis of blood stream infection in patients with malignant hematologic diseases is poor. Gram-negative bacteria are the main pathogenic bacteria and the incidence of drug resistance is high. The resistance to carbapenem antibiotics should be paid attention to. The effectiveness of initial empirical therapy can significantly affect the prognosis.
【作者单位】：北京大学第三医院血液科;
【分类号】：R730.43;R733

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