急性白血病患儿合并败血症病原学及临床特点分析

Etiological characteristics of acute leukemia complicated with septicemia in children and analysis of clinical characteristics

目的探讨急性白血病(AL)合并败血症患儿的病原学特点和临床相关因素,为临床合理使用抗菌药物提供科学依据。方法收集2008年6月-2011年6月240例AL血培养阳性患儿病例,并回顾性分析其病原学特点、感染部位、感染相关因素、治疗及转归。结果 AL合并败血症患儿检出前3位病原菌依次为大肠埃希菌占23.33%、表皮葡萄球菌占11.67%、肺炎克雷伯菌占10.83%;革兰阴性菌对碳青霉烯类抗菌药物敏感率为100.00%,革兰阳性菌对万古霉素及利奈唑胺敏感率为100.00%;发热6h内及时经验应用抗菌药物疗效显著(P<0.05);中性粒细胞计数<0.5×109/L,且粒细胞缺乏持续时间≥7d患儿败血症发生率显著升高(P<0.05)。结论 AL合并败血症患儿检出的病原菌革兰阴性菌多于革兰阳性菌,其与粒细胞缺乏持续时间密切相关,早期经验性应用抗菌药物十分重要。

OBJECTIVE To explore the etiological characteristics of the children with acute leukemia complicated with septicemia and analyze the related factors so as to provide scientific basis for the reasonable clinical use of antibiotics. METHODS A total of 240 acute leukemia children with positive blood culture, who were treated from Jun 2008 to Jun 2011, were enrolled in the study, then the etiological characteristics, infection sites, related factors for infections, treatment, and outcomes were retrospectively analyzed. RESULTS Of the pathogens isolated from the acute leukemia Children complicated with septicemia, the Escherichia coli （23. 33 %）, Staphylococcus epidermidis （11.67 % ）, and Klebsiella pneumoniae （10.83 % ） ranked the top three species. The drug susceptibility rate of the gram-negative bacteria to carbapenems was 100.0 %; the drug susceptibility rates of the gram-positive bacteria to vancomycin and linezolid were 100.00%. The empirical use of antibiotics within 6 hours of fever could achieve significant efficacy（P〈0.05）. The incidence rate of septicemia was significantly increased in the children with the neutrophil count less than 0.5×10^9/L and the duration of neutropenia no less than 7 days（P〈0.05）. CONCLUSION Among the pathogens isolated from the acute leukemia children complicated with septicemia, the detection rate of the gram-negative bacteria is higher than that of the gram-positive bacteria, which is closely related to the duration of neutropenia, and the empirical use of antibiotics in a early stage has become fairly important.