恶性血液病化疗患者院内下呼吸道感染的随访观察

Following-up of nosocomial lower respiratory infection in patients with hematological malignance after chemotherapy

目的随访观察恶性血液病化疗患者下呼吸道感染的危险因素和病原菌变迁。方法对2004年4月—2005年12月的50例各种类型恶性血液病拟准备化疗的患者进行化疗前和化疗后不同时间段的呼吸道菌群定量分析，并对院内感染的细菌进行药敏试验，对院内感染的同一种类的细菌用脉冲场凝胶电泳（PFGE）进行同源性分析。结果恶性血液病患者化疗后下呼吸道感染的发生率为16％。鲍曼不动杆菌、大肠埃希菌和真菌是主要的院内感染致病菌。其中不动杆菌对头孢菌素类、喹诺酮类、氨基糖甙类、碳青霉烯类和含酶抑制剂类抗生素高度耐药，但对头孢哌酮和（或）舒巴坦这一含酶抑制剂类抗生素较为敏感。用PFGE同源性分析结果为2个克隆株。结论恶性血液病化疗患者院内下呼吸道感染的随访观察可以为抗生素的合理使用和预防、控制院内感染的发生提供理论依据。

Objective To observe and investigate the risk factors and pathogen diversification of nosocomial lower respiratory infections in patients with hematological malignance after chemotherapy. Methods Respiratory tract microbial population of fifty patients with different kinds of hematological malignance and para-prepared to chemotherapy was quantitatively analyzed before and after chemotherapy at an arranged time from April ,2004 to December,2005. Susceptibility test was determined for bacterium of nosocomial infection, and the homology of the same species of the bacteria was analyzed by a pulsed field gel electrophoresis （PFGE）. Results Incidence rate of lower respiratory infections in patients with the hematological malignant after chemotherapy was 16%. The major nosocomial infectious pathogens were Acinetobacter spp ; Escherichia coil and Fungus. Among them, Acinetobacter spp, were highly resistant to cephalosporins, quinolones, aminoglycosides, carbapenems and antibiotic with enzyme inhibitor, respectively, but susceptible to Cefoperazone/Sulbactam belonging to antibiotic with enzyme inhibitor. And it was shown that there were two clones by the pulsed field gel electrophoresis （PFGE）. Conclusion Following-up of nosocomlal lower respiratory infection in patients with hematological malignance after chemotherapy might offer theoretical evidence for the rational use of antibiotics and the control of nosocomial infections.