恶性血液病化疗后粒细胞缺乏期医院感染危险因素的分析

Risk factors for nosocomial infection in agranulocytosis patients after chemotherapy to hematological malignancy

目的探讨恶性血液病化疗后粒细胞缺乏患者的机体状态和医院感染的相关性,并分析引起医院感染的危险因素。方法回顾性分析2012年7月—2013年6月上海瑞金医院血液科因恶性血液病入院化疗并在住院期间发生粒细胞缺乏患者的各项临床和实验室检查指标,根据住院治疗期间是否发生医院感染分为无医院感染组(n=68)、临床诊断医院感染组(n=84)和病原学诊断医院感染组(n=62)。三组资料进行单因素分析后,用无序多分类Logistic逐步回归模型进行多因素分析。结果医院感染的发病率为68.22%。多因素分析结果筛选出急性髓系白血病(AML)、住院季节、白细胞计数<0.8×109/L和感染前未使用抗生素预防是发生医院感染的独立危险因素。结论恶性血液病患者化疗后粒细胞缺乏期间医院感染发病率高,应积极对症支持治疗。尤其对于原发病为AML、夏秋季住院化疗和化疗后白细胞计数最低值<0.8×109/L的患者予以抗生素预防可能减少医院感染的发生。

Objective To investigate correlation between nosocomial infection and the characteristics of agranulocytosis patients after chemotherapy to hematological malignancy, and to explore the risk factors. Methods By means of the retrospective study, the clinical and laboratory parameters of 214 agranuloeytosis patients between July 2012 and June 2013 were analyzed. Among them, 68 without any infection were selected as group A; 84 with clinical diagnosis nosocomial infection, group B; and the rest 62 with etiology diagnosis nosocomial infection, group C. The data were analyzed with iterative muhinomial logistic regression model after single factor analysis. Results The incidence of nosocomial infection was 68.22%. The results showed that acute myeloid leukemia （ AML）, seasons of hospitalization, WBC 〈 0.8 ×10^9/L, and no prophylactic antibiotics before infection were independent risk factors of nosocomial infection. Conclusion The incidence of nosocomial infection in agranulocytosis patients after chemotherapy to hematological malignancy is high. In order to improve treatment and prolong survival periods of these patients, good efforts should be taken on to prevent nosocomial infection. Prophylactic antibiotics may reduce the incidence of nosocomial infection, especially for the patients with AML, admitted in summer or autumn, or WBC 〈 0. 8 ×10^9/L.