地西他滨单药或联合低剂量化疗治疗老年急性髓系白血病医院内感染的临床分析

Clinical analysis on nosocomial infection in elderly acute myeloid leukemia patients treated by decitabine alone or with low-dose chemotherapy

目的分析地西他滨单药或联合低剂量化疗治疗老年急性髓系白血病医院内感染的临床特点及易感因素。方法回顾性分析2009年9月至2012年10月接受地西他滨单药或联合低剂量化疗治疗的10例老年急性髓系白血病患者医院内感染发生率、感染部位、致病菌和易感因素等。结果10例老年患者治疗后医院内感染率为70％，例次感染率为46．7％，感染部位以呼吸系统最多见（占52．4％），致病菌以革兰阴性杆菌为主。化疗后骨髓抑制、粒细胞减少者感染率明显增高；与地西他滨联合低剂量化疗方案比较，地西他滨单药方案骨髓抑制、粒细胞减少发生率和医院内感染率降低。结论老年急性髓系白血病患者是医院内感染的易感人群，骨髓抑制、粒细胞减少是其易感因素。地西他滨单药方案治疗老年急性髓系白血病可降低医院内感染发生率。

Objective To investigate the clinical characteristics and susceptible factors ofnosocomial infection in the elderly patients with acute myeloid leukemia（AML） treated by decitabine alone or with low-dose chemotherapy. Methods A retrospective analysis was carried out on 10 elderly patients with AML who were treated by decitabine with or without low-dose chemotherapy in our department from September 2009 to October 2010. The incidence of nosoeomial infection, most commonly infected sites, pathogenic bacteria and the susceptible factors were collected and analyzed in the cohort during the chemotherapeutic period. Results The incidence of nosocomial infection was 70%, and case infection rate was 46.7% in this study. The most commonly infected site was respiratory system, accounting for 52.4%, and the common pathogenic bacteria were mainly Gram-negative ones. There was a markedly increased infection rate in the patients with myelosuppression and neutropenia. The incidence of myelosuppression and neutropenia was lower in the regimen of single deeitabine than that in the schedule of decitabine combined with low-dose chemotherapy. Conclusions The elderly patients with AML are susceptible to nosocomial infection. Myelosuppression and neutropenia are the susceptible factors for the infection. Exclusive decitabine regimen reduces the incidence of nosocomial infection in these elderly patients.