多发性骨髓瘤患者住院化疗感染的临床特征及影响因素研究

Clinical features and risk factors for infecfions in multiple myeloma during chemotherapy

目的:研究多发性骨髓瘤(multiple myeloma,MM)患者住院化疗感染的临床特征,探讨感染的影响因素,为院内感染的防治提供依据。方法:回顾性分析2012年1月至2016年3月嘉兴学院附属第一医院住院化疗的153例MM患者临床资料,研究感染的临床特征及影响因素。结果:153例多发性骨髓瘤患者累计完成化疗415个疗程,其中150个疗程出现感染,占36.14%;常见的感染部位为呼吸道(49.25%)、消化道(16.42%)、泌尿道(13.43%)和口腔(7.46%)。共检出74株病原菌,其中革兰阴性菌占71.62%,革兰阳性菌占17.57%。Logistic多元回归分析显示,合并有糖尿病(95%CI:6.572-80.650,OR=22.359,P<0.001)、住院时间>20 d(95%CI:1.785-29.169,OR=17.328,P<0.001)、ISS分期高(95%CI:4.974-35.247,OR=12.894,P<0.001)是MM患者住院化疗感染的独立危险因素。结论:MM患者住院化疗容易并发各种病原菌感染,合并糖尿病、住院时间>20 d以及根据国际分期系统(ISS)分期高的患者感染发生率更高;对于合并有糖尿病、住院时间>20 d以及ISS分期高的患者应积极采取有效的预防和控制感染措施。

AIM： To observe the clinical characteristics of infections in multiple myeloma（ MM）patients during chemotherapy in hospital,and to identify the risk factors for infection and provide the basis for prevention and control of nosocomial infections. METHODS： A retrospective study of patients with MM who underwent chemotherapy between Jan 2012 and Mar 2016 in the First Affiliated Hospital of Jiaxing University was conducted. Clinical features and risk factors for infections were analyzed. RESULTS： One hundred and fifty three patients with MM received a total of 415 courses of chemotherapies. During which 150（ 36. 14%） infections episodes occurred. The common infections sites were respiratory tract infection（ 49. 25%）,gastrointestinal tract infection（ 16. 42%）,urinary tract infection（ 13. 43%） and oral infection（ 7. 46%）. Seventy-four strains of pathogenic bacteria were detected. Gram-negative bacteria were observed in 71. 62% of documented pathogens,and Gram-positive bacteria were responsible for 17. 57%of infections. Multivariate unconditioned logistic analysis of factors identified consistent independent risk factors for complication of diabetes mellitus（ 95% CI： 6. 572-80. 650, OR = 22. 359, P〈0. 001）,hospitalization time longer than 20 days（ 95% CI： 1. 785-29. 169, OR = 17. 328, P〈0. 001）, and high ISS stage（ 95% CI： 4. 974-35. 247,OR = 12. 894,P〈0. 001）. CONCLUSION： Patients with MM tended to be infected with various species of pathogens after the chemotherapy;MM patients with complication of diabetes mellitus,hospitalization time longer than 20 days,and high ISS stage faced an increased risk of infections by multivariate analysis. It is necessary for the hospital to strengthen the risk assessment for the patients and take effective prevention and control measures for the patients complicated with diabetes, hospitalization interval longer than 20 days,or high ISS stage.