849例次急性白血病患者院内感染情况分析

Infection analysis of 849 patients with acute leukemia

目的:探究急性白血病患者合并院内感染的临床特点、病原菌种类、病原菌分布和耐药情况。方法:以2015年1月至2016年9月盛京医院血液科急性白血病患者为研究对象,采用回顾性分析的方法对患者院内感染的临床特点进行收集分析,分离不重复的病原菌株,分析其耐药率。结果:849例次急性白血病患者院内感染的发生率为43. 34%,主要感染部位为呼吸道。368例次发生院内感染的患者中,共检出病原菌43株,病原菌主要为大肠埃希菌(23. 26%)、铜绿假单胞菌(20. 93%)和肺炎克雷伯氏菌(13. 95%)等。所检出的病原菌对常用抗菌药物耐药性高,对碳青霉烯类敏感性高。结论:急性白血病患者院内感染率高,细菌培养阳性率低,多依靠于经验性治疗。革兰氏阴性杆菌仍是目前此类患者院内感染最主要的致病菌,不排除多种耐药菌和真菌感染。合理应用抗生素、缩短患者粒缺状态持续时间、加强院感宣教及病房管理,可能减少院内感染的发生。

Objective：To investigate the clinical characteristics,the types as well as drug resistance of pathogens in patients with acute leukenfia complicated with nosoconfial infection. Methods：The subjects were selected from the inpatients with acute leukenfia in the Department of Hematology of Shengjing Hospital from January 2015 to September 2016. In retrospective ways ,we collected and analyzed the clinical characteristics of the patients with nosoconfial in-fection, and isolated the non-repeated pathogenic strains and analyzed their tolerance rate. Results ： The incidence of nosocomial infection in 849 cases of acute leukenfia was 43.35 % , and the main infection was respiratory tract. A total of 43 pathogenic strains were detected from 368 cases with nosocomial infection, mainly including Escherichia coli （ 23.26 % ）, Pseudomonas aeruginosa （ 20.93 % ） and Klebsiella pneumoniae （ 13.95 % ）. These pathogens were highly resistant to comnlon antibiotics but sensitive to carbapenems. Conclusion：Patients with acute leukemia have high inci-dence of nosocomial infection and the positive rates of bacteria culture are low, as a result of which, the treatmentgenerally depends on clinical experiment. Gram-negative bacillus is still the main pathogen in the case with nosoco-mial ilffection, without exclusion of multiple drug-resistant bacteria and fungus. To reduce the incidence of nosocomi-al infection, we should use antibiotics rationally, shorten the duration of granulocyte deficiency for patients, and strengthen the education about nosocomial infection as well as ward managenlent.