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

Application of Antimicrobial Drugs for Leukemia Patients with Granulocyte Deficiency and Fungal Infection after Chemotherapy

目的探究白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物的使用情况,为临床制定合理使用抗生素方案提供参考依据。方法回顾性分析淄博市中心医院收治的110例白血病化疗后粒细胞缺乏伴真菌感染患者的一般资料,采用该院自制的白血病化疗后粒细胞缺乏伴真菌感染患者抗菌药物使用情况调查表进行统计,最后根据统计结果进行分析。结果 110例患者中感染部位主要为呼吸道(47.27%)、其次为口腔或消化道(32.73%);通过经验性用药治疗有效率占60.91%;43例经验救治无效后使用补救方案治疗后,有效率达到93.02%,其中1例由于产生不良反应而停止使用,1例由于因感染性休克死亡。经验性用药为单一他唑巴坦/哌拉西林(27.27%)、伊曲康唑(10.00%),而联合用药主要为伊曲康唑+头孢他啶(17.27%),其次为伊曲康唑+万古霉素(9.09%);在经验治疗无效后,使用抗菌药物频率最高的为单一使用氟康唑(23.26%),其次为哌拉西林/他唑巴坦(16.28%),联合用药频率最高的为氟康唑+万古霉素(9.30%),其次为哌拉西林/他唑巴坦+万古霉素(6.98%)。结论该院抗菌药物使用情况合理,针对白血病化疗后粒细胞缺乏伴真菌感染患者应根据患者感染情况,合理选择抗菌药物。

Objective To explore the application of antimicrobial drugs for leukemia patients with granulocyte deficiency and fungal infection after chemotherapy, and to provide reference basis for rational usage of antibiotics clinically. Methods Gen- eral data of 110 cases of leukemia with granulocyte deficiency and fungal infection after chemotherapy were analyzed retrospective- ly by using the questionnaire for the usage of antimicrobial drugs on leukemia patients with granulocyte deficiency and fungal in- fection after chemotherapy made, and were analyzed according to the statistical results. Results In 110 cases, the main infection sites were respiratory tract（47.27% ） ,followed by mouth or digestive tract（32.73% ）. The treatment effective rate was 60.91% with empirical drug use, and 43 cases were ineffective after treatment, then the effective rate was 93.02% after remedy treatment, with 1 case discontinued due to adverse reactions, and 1 case died due to septic shock. Empirical drugs were single tazobactam/ piperacillin （ 27. 27% ） , itraconazole （ 10. 00% ） , and combined usage of drugs mainly were itraconazole plus ceftazidime （ 17.27 % ） , secondly, itraconazole ＋ vaneomycin （ 9.09 % ）. If the treatment was invalid, antimicrobial drug of the highest usage was single use of fluconazole （23.26%）, followed by piperacillin/tazobactam（ 16.28% ） , and the eombinated usage were flueon- azole ＋ vancomycin（9.30% ）, followed by piperacillin/tazobactam ＋ vancomycin （6.98%）. Conclusion The use of antibiotics is basically reasonable for leukemia patients with granulocyte deficiency and fungal infection after chemotherapy, it should choose antimicrobial drugs according to specific infection of patients.