恶性血液病患者化疗后医院感染及抗感染治疗分析

Hospital Infection after Chemotherapy in Patients with Hematological Malignancies and its Anti-infection Therapy

目的探讨恶性血液病患者化疗后出现医院感染的临床特点及其治疗方案。方法回顾性分析50例恶性血液病患者化疗后出现感染的部位、感染的严重程度、致病菌检查结果、白细胞及中性粒细胞水平、抗感染的治疗方案及疗效。结果恶性血液病患者化疗后容易出现感染,感染率50%(25/50);初次化疗患者61.5%(16/26)出现感染,其中42.31%(11/26)发生重症感染;再次化疗患者37.50%(9/24)出现感染,其中8.33%(2/24)发生重症感染;化疗后出现的感染中呼吸道感染占44%,临床表现不典型,发热常为感染的唯一表现,致病菌检查阳性率仅38.46%;广谱抗菌药的降阶梯治疗有效率93.75%。结论恶性血液病化疗后粒细胞缺乏期易出现感染,特别是初次化疗的患者极易出现重症感染,其临床表现不典型,及时使用广谱抗菌药进行降阶梯治疗能够取得较好的疗效。

Objective To investigate the factors of hospital infection after chemotherapy in patients with hematological malignancies, and discuss the therapy methods. Methods 50 patienents with hematological malignancies were analyzed retrospectively about hospital infection location and severity,pathogen,leucocyte and neutrophil count or antimicrobial regimens and its effect. Results patients with hematologic malignancies after chemotherapy were susceptible to infection since low white blood cell count, and the infection rate is 50% （25/50）. After primary chemotherapy, 61.5%（16/26） patients were infected, of which 42.31%（11/26） were severe infection;and 37.50%（9/24） infection rate after secondary chemotherapy with 8.33%（2/24） severe infection. 44%（ 11/25 ） infections occurred in respiratory tract after chemotherapy, the clinical manifestations were atypical, fever was often the only symptom, pathogen-positive rate was only 38.46% ,de-escalation therapy with broad-spectrum antimicrobial had distinctirely effective power 93.75%. Conclusion Patients with hematological malignancies after chemotherapy were susceptible to infection during neutropenia,and were easily occuring severe infections,manifesting atypical symptoms, particularly after primary chemotherapy; De-escalation therapy with Broad-spectrum antimicrobial could get better effect.