儿童急性白血病化疗后骨髓抑制期感染的临床分析

Clinical Analysis on Bone Marrow Suppression Phase of Acute Leukemia after Chemotherapy Infection among Children

目的:分析急性白血病(AL)患儿化疗后骨髓抑制期感染的临床特点及血培养刚性细菌对抗生素的敏感性,探讨其防治措施。方法:回顾性分析住院AL患儿化疗后进入骨髓抑制期其感染的发生率;血培养刚性细菌对抗生素的耐药性及敏感性;血培养阳性与血培养阴性患儿在骨髓抑制期的时间及抗生素使用时间的差异。结果:AL患儿骨髓抑制期感染的发生率为75.8%(72/95),其中血培养阳性率为26.4%(19/72)。血培养阳性组以肠道感染较多(47.6%),其主要病原菌为大肠埃希菌、铜绿假单胞菌、葡萄球菌属。三种病原菌对青霉素类、头孢三代抗生素、红霉素的耐药率均较高,葡萄球菌属对万古霉素和利奈唑烷相对较敏感,大肠埃希菌对碳青霉烯类抗生素敏感性较高。铜绿假单胞菌对碳青霉烯类抗生素和哌拉西林/他巴唑较敏感,对复方新诺明耐约者较多。血培养刚性组患儿在中性粒细胞缺乏持续时间为(9.37±5.20)d,抗生素使用时间为(16.53±6.29)d,两项指标在血培养刚性组与阴性组之间的差异有显著性。结论:AL患儿骨髓抑制期易发生感染,如考虑革兰阴性菌感染可选择碳青霉烯类,如考虑革兰阳性菌感染可选择万古霉素及利奈唑烷,必要时根据细菌药物敏感试验调整抗生素。

Objective To analyze the clinical characteristics of Bone marrow suppression phase＇s infection in children with acute leukemia （AL）, including bacterial sensitivity to antibiotics and the strategy of prevention antreatment. Methods The incidence rate of one marrow suppression phase＇s infection in children with AL were analyzed retrospectively. Positive blood culture bacterial resistance to antibiotics and sensitivity; blood culture positive and negative blood cultures in patients with bone marrow depression period time and antibiotic use time difference were analyzed. Results The incidence rate of Bone marrow suppression phase＇s infection was 75.8% （72/95）, The positive rate of hemoculture was 26.4% （19/72）. Blood culture positive group to enteric infection more （47.6%）, Escherichia coli,Pseudomonas aeruginosa and Staphylococcus showed higher resistance to penicillins, third generation cephalosporin antibiotics and erythromyci. Staphylococcns showed sensitivity to vancomycin and linezolid; Escherichia coil were more sensitive to imipenem; Pseudomonas aeruginosa were sensitive to imipenem and Piperacillin/methimazole, hot resistance to cotrimoxazole. Conclusions Children with AL are often complicated with Bone marrow suppression period prone to infection during chemotherapy, and easy to get bacterial infections. AL children with Gbacterial infections could he treated with carhapenems, while those with G ＋ bacterial infections could be treated with vancomycin or linezolid. It is necessary to detect bacterial sensitivity to antibiotics in order to improve the therapeutic effect.