急性白血病院内下呼吸道感染临床分析

CLINICAL ANALYSIS OF NOSOCOMIAL LOWER RESPIRATORY TRACT INFECTIONS IN PATIENTS WITH ACUTE LEUKEMIA

目的 探讨急性白血病院内下呼吸道感染的发病情况，危险因素及病原学特点。方法 对1990-1999年10月的372例急性白血病住院患者进行回顾性调查。分析总结。结果 急性白血病院内下呼吸道感染发病率为15.6%。病死率48.3%。白细胞下降，年龄、激素、化疗、广谱抗生素的使用及住院时间长是院内下呼吸道感染的主要危险因素。铜绿假单胞菌，大肠杆菌，克雷伯菌属及真菌是主要致病菌，亚胺培南，头孢他啶，阿米卡星及环丙沙星对革兰阴性杆菌有较强的抗菌活性，但近两年大肠杆菌和克雷伯菌对阿米卡星及环丙沙星抗药性增加。结论 对白细胞小于1.5×10^9/L的病人进行保护性隔离并合理使用抗生素治疗是必要的措施。

Objective\ To investigate the incidence,risk factors and microbiologic characteristic of nosocomial lower respiratory tract infections in patients of acute leukemia.Methods\ 372 inpatients with acute leukemia were with retrospectively studied.Results\ The nosocomial lower respiratory tract infection rate was 15.6%,and the death rate was 48.3%.The major risk factors were WBC decline,age,chemotherapy,hormones and overuse of antibiotics,and long stay in hospital.P.aeruginosa,E.coli,Klebsiella and fungi were the main microorganisms.The more active antibiotics against Gram negative bacillus were Imipenem,Ceftazidime,Amikacin and Ciprofloxacin.But the resistant strains of E.coli and Klebsiella were increased in recent two years.Conclusions\ It is necessary to take protective isolation to the patients with lower WBC(<1.5×10 9/L) and a resouable usage of antibiotics.