急性白血病患者血流感染的临床特征及治疗策略

Clinical characteristics of bloodstream infections in patients with acute leukemia and treatment strategies

目的探讨急性白血病（AL）患者血流感染的临床特点、病原菌分布、药敏特征、抗菌药物选择及对疗效的影响。方法回顾性分析2010年1月-2012年7月227例AL患者血流感染的特点及不同抗菌药物治疗后转归并进行对照研究。结果患者中无明确感染灶占8.1%,大多数伴有感染症状,包括肺部占31.4%;肛周占26.9%;胃肠道占17.5%;口腔占16.7%;上呼吸道占9.2%;皮肤软组织占7.8%;菌群分布：革兰阴性菌269株占74.7%、革兰阳性菌80株占22.2%、真菌11株占3.1%;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦钠敏感性70.0%~90.0%,鲍氏不动杆菌对多种抗菌药物耐药,革兰阳性菌及真菌对临床常用抗菌药物保持极高的敏感性;269例次革兰阴性菌血流感染中,243例次治疗有效,治疗有效率为90.3%;80例次革兰阳性菌血流感染中,76例次治疗有效,治疗有效率为95.0%;11例次真菌血流感染中,9例次治疗有效,治疗有效率为81.8%。结论 AL患者血流感染仍以革兰阴性菌为主,临床治疗应根据药敏试验调整用药,提高治疗的成功率,减少患者死亡。

OBJECTIVE To explore the clinical characteristics of bloodstream infections in patients with acute leukemia（AL）,analyze the distribution and drug susceptibility of pathogens,and observe the effects of antibiotics.METHODS The characteristics of bloodstream infections in 227 AL patients who were treated in the hospital from Jan 2010 to Jul 2012 were retrospectively analyzed,and a case control study was conducted to observe the treatment outcomes.RESULTS The patients without clear focal infections accounted for 8.1%,most of them were complicated with symptom of infections,of whom 31.4% had pulmonary infections,26.9% had perianal infections,17.5% had gastrointestinal tract infections,16.7% had oral infections,9.2% had upper respiratory tract infections,and 7.8% had skin and soft tissue infections.Among the isolated pathogens,there were 269（74.7%）strains of gram-negative bacteria,80（22.2%）strains of gram-positive bacteria,and 11（3.1%）strains of fungi.The drug susceptibility rates of the Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa to imipenem,cefoperazone-sulbactam,and piperacillin-tazobactam varied from 70.0% to 90.0%;the Acinetobacter baumannii strains were resistant to multiple antibiotics.The gram-positive bacteria and fungi remained extremely susceptible to the commonly used antibiotics.Of the 269case-times of bloodstream infections caused by the gramnegative bacteria,243 were effective for the treatment,with the effective rate 90.3%.Of the 80case-times of bloodstream infections caused by the gram-positive bacteria,76 were effective for the treatment,with the effective rate 95.0%.Of the 11case-times of bloodstream infections caused by the fungi,9were effective for the treatment,with the effective rate 81.8%.CONCLUSION The gram-negative bacteria remain dominant among the pathogens causing the bloodstream infections in the AL patients.It is necessary for the hospital to adjust the drug administration based on the result of the drug susceptibility testing so as to raise the success rare of treatment and reduce the mortality rate.