急性白血病患者化疗后粒细胞缺乏合并医院感染的临床分析

Clinical analysis on 48 cases with acute leukemia and chemotherapy induced agranulocytosis complicated with hospital infection

目的分析总结急性白血病患者化疗后粒细胞缺乏伴医院感染的临床特点,便于指导临床用药。方法回顾总结48例急性白血病住院患者化疗后并发感染,采用"降阶梯治疗"的策略,合理应用抗菌药物等治疗的相关临床资料。结果 48例急性白血病患者化疗后发生医院感染36例,感染率为75.0%。治疗有效33例占91.67%,感染直接导致死亡3例占8.3%。感染部位以呼吸道最为常见,共16例占44.44%,其次为消化道感染8例占22.22%,肛周感染5例占13.89%,泌尿系感染3例占8.33%,其他部位如皮肤等感染4例占11.11%。病原学检查分离培养出病原菌44株,其中G-杆菌27株占61.36%,G+球菌17株占38.64%,真菌6例占13.64%。结论急性白血病患者化疗后粒细胞缺乏合并医院感染的发生率高,在应用粒细胞集落刺激因子同时合理使用抗菌药物是控制医院感染的有效方法。

Objective To analyse and summarize the clinical characteristics of acute leukemia and chemotherapy induced agranulocytosis associated with hospital infections so as to direct clinical medication. Methods The clinical data of 48 cases of acute leukemia and chemotherapy induced agranulocytosis associated with hospital infection received “de-escalation therapy” and rational antibacterials therapy. Results Among the 48 patients,36 of acquired hospital infection after chemotherapy,infection rate was 75.0%; 33 were cured（91.67%）,3 died due to very severe infection （8.3%）. Respiratory tract infection occupied 44.44% being in the most proportion,secondaryly 8 of alimentary infection,5 from crissum infection （13.89%）,3 from urinary system infection （8.33%）,the other site infection in 4 cases （11.11%） were as skin infection and so on. Forty-four strains of pathogenic bacteria were isolated and cultured for etiology examination,including 27 strains of G- bacilli（61.36%）, 17 strains of G＋ coccus（38.64%）,6 strains of fungi（13.64）. Conclusion There is a high rate in acute leukemia chemotherapy induced agranulocytosis complicated with hospital infections. Rational use of antibacterials,at the same time,of granulocyte colony-stimulating factor is an effective control to the hospital infection.