60例儿童异基因造血干细胞移植后早期感染的临床分析

Nosocomial Infections During Early Stage after Allogeneic Hematopoietic Stem Cell Transplantation:A Clinical Investigation of 60 Children Cases

目的探讨儿童患者异基因造血干细胞移植后早期感染的临床特点。方法对儿科2000年1月-2006年8月,进行异基因造血干细胞移植的60例儿童患者,在移植后早期感染的发生部位、感染因素及感染种类等作回顾性分析。结果60例儿童患者在移植早期54例发生了不同程度的感染,发生率为90.00%。感染部位以呼吸道感染为首位,占64.82%,其次是口腔黏膜、胃肠道、皮肤等,未发现感染病灶者8例;移植早期感染种类以细菌为主,合并真菌感染7例,占12.96%;合并急性移植物抗宿主者感染的发生率高;所有患者在预处理结束后不久即开始使用抗菌药物治疗,开始时间为(1.3±2.4)d。结论儿童患者异基因造血干细胞移植早期感染的发生率非常高,以革兰阴性菌为主,且真菌感染的发生率也明显增高,合理使用抗菌药物、预防真菌感染等是防治异基因造血干细胞移植患者早期感染的重要措施。

OBJECTIVE To investigate the clinical characters of nosocomial infections in children patients with allogeneic hematopoietic stem cell transplantation （alloHSCT） during the early stage of transplantation. METHODS The clinical characters of infections in the early stage after transplantation were analyzed retrospectively in 60 children cases from Jan 2000 to Aug 2006. RESULTS The incidence rate of nosocomial infection in the early stage of transplantation was 90.00%. Nosocomial infection occurred mainly in patients were the respiratory tract （64.82%）, oral cavity, intestinal tract, blood, and skin. No infection focus was seen in 8 cases. The main pathogens of the early stage were microbes, and fungal infection was 13. 0%. The patients complicated with acute graft-versus-host disease had higher infection rate. All the patients were given the antibiotic treatment after the ending of regimen, the time was （1.3±2.4） d. CONCLUSIONS There is a higher incidence of nosocomial infection in children patients in early stage after alloHSCT. The pathogens are mainly Gram-negative bacteria. There is a higher incidence of fungal infection too. A reasonable antibiotics and preventing the fungal infection are good to control nosocomial infection in children malignancies.