血液肿瘤患儿医院获得性血流感染的临床特点

Clinical characteristics of nosocomial bloodstream infection in children with hematological malignancies

目的了解血液肿瘤患儿医院获得性血流感染(nosocomialblood stream infection,NBSI)的临床特点及病原体分布和耐药性,为临床上预防NBSI及早期合理应用抗菌药物提供依据。方法回顾2011年1月至2013年12月血液肿瘤住院治疗并发生NBSI患儿的临床资料和血培养结果 ,分析患儿的临床表现特点,病原菌分布及耐药性、治疗方法及转归。结果发热及C反应蛋白(CRP)增高是NBSI患儿共有的表现,细胞因子中IL-6和IL-10增高发生率在50%以上。1 500例次住院患儿发生NBSI161例次,发生率10.73%(161/1500),其中血培养阳性70例,阳性率为43.48%(70/161);70例血培养阳性患儿共检出病原菌79株,革兰阳性菌55.70%,革兰阴性菌43.04%,真菌1.27%;排在前3位的病原菌依次为表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌,分别占20.25%、15.19%、15.19%;葡萄球菌对万古霉素、利奈唑胺敏感,大肠埃希菌、肺炎克雷伯菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南敏感。结论血液肿瘤患儿发生NBSI缺乏特异症状体征,CRP及IL-6和IL-10可能有助于NBSI的诊断。NBSI病原学以革兰阳性菌为主,早期联合用药是成功治疗血液肿瘤患者NBSI的关键。

Objective To review the clinic characteristics, the pathogens distribution and antibiotic resistance of noso- comial bloodstream infections （NBSI） in children with hematological malignancies. Methods The clinical data of children with hematological malignancies admitted in the hospital from January 2011 to December 2013 were retrospectively reviewed. The pathogenic bacteria were isolated and identified with VITEK60 and Kirby-Bauer methods from patients with NBSIs and their drug resistance was analyzed. Results Among 1 500 patients with hematological malignancies, 161 cases were complicated with NBSI with a incidence rate of 10.73%（161/1 500）. Fever and increased CRP were common, increased cytokines IL-6 and IL-10 were detected in more than 50% patients, however, there was lack of specific symptoms and signs in NBSI patients. Seventy nine bacterial strains were isolated from blood specimens of 161 patients. Gram-positive cocci, Gram-negative bacilli and fungi were accounted for 55.70%, 43.04% and 1.27% of all isolates, respectively. Staphylococcus epidermidis （20.25%）, Escherichia coli （15.19%） and Klebsiella pneumoniae （15.19%） were frequently identified isolates. Staphylococci were susceptible to vancomycin and linezolid; Escherichia coil and Klebsiella pneumoniae were sensitive to cefoperazone/sulbactam, imipenem and meropenem Conclusion NBSI in children with hematological malignancies lacks specific symptoms and signs, the increased CRP, IL-6 and IL-10 might be helpful for diagnosis of NBSI.