造血干细胞移植患者粒细胞缺乏期间血流感染的单中心临床分析

Blood stream infections during agranulocytosis period after hematopoietic stem cell transplantation in one single center

目的 分析造血干细胞移植（HSCT）患者粒细胞缺乏（粒缺）期间血流感染的流行病学特征,为经验性治疗的选择提供依据.方法 回顾性分析我院2008年1月至2010年10月784例HSCT在粒缺期发热的患者,分析其血流感染的发生率、临床表现、病原菌分布及药敏试验结果.结果 784例HSCT患者中441例在粒缺期间出现发热,确定为血流感染者75例,在所有患者中发病率为9.6%（75/784）,在粒缺发热患者中发病率为17.0%（75/441）.病原菌分布依次为：G-菌株占64.4%,产超广谱β内酰胺酶（ESBL）菌株占80.9%（38/47）,除1株鲍曼不动杆菌外均对碳青霉烯类药物敏感;G＋菌株占30.1%,耐甲氧西林葡萄球菌比例为50.0%,除1株鹑鸡肠球菌外均对万古霉素敏感;真菌菌株占5.5%,均为念珠菌属.HSCT患者在粒缺期血流感染的病死率为6.7%.结论 我院骨髓移植病房的血流感染病原菌分布依次为G-菌、G＋菌和真菌.碳青霉烯类及糖肽类药物分别是前两者治疗的首选.

Objectlve To analyze the epidemiologic features of blood stream infection（BSI）during the period of agranulocytosis after hematopoietic stem cell transplantation（HSCT）in our hospital,and provide the basis for the empirical therapy.Methods The consecutive hematopoietic stem cell transplantation recipients conducted between January 2008 and October 2010 were studied retrospectively,to identify the current incidence,etiology for BSI and associated mortality during the period of agranulocytosis.Results Totally 75 patients were diagnosed as BSI.The incidence of BSI was 9.6%（75/784）in HSCT during the period of agranulocytosis,17.0%（75/441）in febrile patients.The pathogen testing showed that 64.4%were G-bacteria,30.1%were G＋ bacterial and 5.5%were fungi.All G-bacteria except one were sensitive to carbapenems;all G＋ bacteria except one were sensitive to vancomycin.Among the 75 patients,9（12.0%）experienced septic shock and 5（6.7%）died.Conclusions The pathogens of the BSI in the cohort are G-bacteria,followed by G＋ bacteria and fungi.Carbapenems and vancomycin are the first drugs for the experiential therapy.