血液科住院患者血流感染的病原菌分布特点及临床高危因素分析

Mortality and risk factors related to blood stream infection in patients from hematological department

目的:探讨血液科住院患者发生血流感染的病原菌分布特点及可能引起血流感染的内外源性高危因素。方法:采用前瞻性队列研究方法,将血液科2014年01至12月92例血培养阳性患者作为研究对象,将同时期抽取血培养的92例血培养阴性患者作为对照组,将其血流感染前可能存在的内外源性高危因素进行分层研究,并随访患者血流感染后的住院时间及生存情况,相关数据采用SPSS软件进行统计学分析。结果:血液科2014年血流感染主要为革兰阴性杆菌(73.91%),前5位依次为大肠埃希菌(30.43%)、肺炎克雷伯杆菌(15.22%)、鲍曼不动杆菌(6.52%)、嗜水气单胞菌(5.43%)、铜绿假单胞菌(4.35%);其次为革兰阳性球菌(19.57%),前3位依次为肺炎链球菌(5.43%)、施氏葡萄球菌(3.26%)、草绿色链球菌(3.26%);真菌(6.52%)皆为念珠菌属。粒细胞缺乏及合并弥散性血管内凝血(DIC)在2组之间差异有统计学意义(P<0.01)。在30d随访期内,血流感染组的死亡率(38.04%)明显高于对照组(21.74%)。结论:血流感染是影响血液病住院患者疗效的一个重要不利因素。而中性粒细胞缺乏或合并DIC状态是引起血液病患者血流感染发生的高危因素。

Objective：To discuss the mortality and the risk factors related to blood stream infection in patients from hematological department. Method： A prospective study enrolled 92 patients diagnosed as blood stream infection from Department of Hematology in 2014. Ninety-two patients with negative blood cultures at the same time and the same ward were used as the control group. The potential risk factors were stratified and analyzed. A 30- day follow-up was then performed. Mortality and hospital stay were defined as endpoint. Result： Gram-negative bacilli was 73.9% ,gram-positive cocci was 19.57%. DIC and neutropenia were two predisposing factors related with blood stream infection. Moreover, cases presented higher mortality compared to controls （38.04% vs 21.74 %）. Conclusion：Blood stream infection is one of the most adverse factors affecting the treatment efficacy in patients with hematological disease. Patients with DIC or neutropenia are more likely to have blood stream infection.