白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的应用研究

Study on use of antimicrobial drugs by leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy

目的探讨白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的应用,为临床白血病治疗提供药物治疗依据。方法回顾性分析2013年8月-2014年10月医院收治的120例白血病化疗后粒细胞缺乏伴真菌感染患者临床资料;所有中性粒细胞〈0.5×10^9/L患者均应用粒细胞集落刺激因子,白血病粒细胞缺乏伴发热患者首先经验性抗细菌治疗,直至获得准确的病原学培养结果选用抗菌药物;对疑似真菌感染的患者,先给予氟康唑治疗5~12d;拟诊或临床诊断以及确诊真菌感染后分层使用抗真菌药物;调查患者治疗后临床症状改善情况,采用SPSS 20.0软件对数据进行统计分析。结果 120例感染患者检出真菌以白色假丝酵母菌为主,占60.8%;经抗真菌药物治疗后治疗有效112例,有效率为93.3%;治疗24~48h后体温下降,临床症状有所改善;患者应用粒细胞集落刺激因子3~5d后,血白细胞升至1.0×10^9/L以上,中性粒细胞升至0.5×10^9/L以上;8例患者因感染性休克死亡,病死率6.7%;16例发生不良反应,发生率13.3%。结论白血病患者化疗后粒细胞缺乏伴真菌感染患者,应根据病原菌鉴定和药敏试验的结果合理选择抗菌药物,并对真菌感染患者采用预防性抗真菌治疗。

OBJECTIVE To explore the use of antibiotics by leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy so as to provide guidance for drug therapy.METHODS The clinical data of 120 leukemia patients complicated with agranulocytosis and fungal infections after chemotherapy who were treated in the hospital from Aug 2013 to Oct 2014 were retrospectively analyzed.The patients with neutrophils counts less than 0.5 ×10^9/L were treated with granulocyte colony stimulating factors,the leukemia agranulocytosis patients complicated with fever were firstly given the empirical antibacterial treatment and then treated with antibiotics till the accurate result of etiological culture was obtained.The patients with suspected fungal infections were firstly treated with fluconazole for 5-12 days and then given hierarchical use of antifungal drugs.The use of antimicrobial drugs and improvement of clinical symptoms were investigated,the statistical analysis of data was performed with the use of SPSS20.0software.RESULTS The Candida albicans was dominant among the fungi isolated from the120 leukemia agranulocytosis patients complicated with fungal infections,accounting for 60.8%.The antifungal drug therapy was effective in 112 cases,with the effective rate of 93.3%.The body temperature dropped after the treatment for 24-48 hours,and the clinical symptoms were improved;the white blood cell counts of the patients with neutrophils counts less than 0.5×10^9/L rose to more than 1.0×10^9/L after they were treated with granulocyte colony stimulating factors for 3-5days,and the neutrophils counts rose to more than 0.5×10^9/L.Totally 8patients died of septic shock,with the mortality rate of 6.7%,and 16 cases had adverse reactions,with the incidence rate of 13.3%.CONCLUSION As for the treatment of the leukemia patients complicated with agranulo cytosis and fungal infections after chemotherapy,it is necessary to reasonably use antibiotics on the basis of the results of identification of pathogens and drug susceptibility testing and conduct the preventive antifungal therapy for the patients with fungal infections.