恶性血液病患者化疗后并发败血症的临床分析

Clinical analysis of septicemia in hematologic malignancies patients after chemotherapy in

目的研究恶性血液病患者化疗后并发败血症的易感因素、病原菌分布、感染部位、预后及治疗,为临床合理使用抗菌药物提供参考依据。方法回顾性分析2008年1月-2011年12月80例恶性血液病患者化疗后并发败血症的临床资料及药敏试验结果。结果 80例恶性血液病并发败血症患者中有68例处于化疗后粒细胞缺乏期占85.0%,;大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌是前3位病原菌,分别占32.5%、20.0%、8.8%;革兰阴性菌和革兰阳性菌最敏感药物分别为美罗培南和利奈唑胺;以碳青霉烯类为主的经验用药可以覆盖81.6%的败血症病原菌。结论革兰阴性菌是恶性血液病化疗后合并败血症的主要致病菌,以碳青霉烯类为主的经验性降阶梯治疗可提高败血症的治愈率;粒细胞缺乏、并发肺部感染、合并感染性休克、血液病疾病状态及经验用药与药敏相符度是影响转归的因素。

OBJECTIVE To investigate the susceptible factors, bacterial distribution, infection site, prognosis and treatment of septicemia in the hematologic nla[ignancies patients after chemotherapy so as to guide the rational use of antibiotics. METHODS A total of 80 cases of hematologic malignancies patients complicated with septicemia, who underwent the chemotherapy from Jan 2008 to Dec 2011, were enrolled in the study, then the clinical data and the result of drug susceptibility testing were retrospectively analyzed. RESULTS Of totally 80 cases of hematologic malignancies patients complicated with septicemia, 85.0% （68 cases ） happened during the period of granulocyto- penia. The Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the top three species of pathogens, accounting for 32.5%, 20. 0%, and 8. 8%, respectively. Meropenem and linezolid were the most sensitive antibiotics against the gram-negative bacteria and the gram-positive bacteria. 81.6% of the pathogenic bacteria causing the septicemia could be covered by empirical use of carbapenems antibiotics. CONCLUSION The gram-negative bacteria are the predominant pathogens in the hematologic malignancies patients complicated with septicemia after chemotherapy. The de-escalation therapy dominated by the carbapenems antibiotics can improve the cure rate of sepsis. The agranulocytosis, complication of pulmonary infection, septic shock, hematologic dis- ease, empirical medication, and accordance to the drug susceptibility were the factors that could influence the prognosis.