诱导期初治多发性骨髓瘤患者医院感染的临床特征

Clinical characteristics of healthcare-associated infection in initially treated patients with multiple myeloma during the induction period

目的探索初诊多发性骨髓瘤(MM)患者诱导治疗期间医院感染发生情况及临床特征。方法收集某医院接受PAD(硼替佐米+阿霉素+地塞米松)与PDD(硼替佐米+脂质体阿霉素+地塞米松)方案治疗的116例初治有症状的MM患者临床资料,统计诱导治疗期间感染率及临床特点。结果 116例MM患者其中69例接受PAD方案治疗,47例接受PDD方案治疗,两组的感染发生率分别为79.7%和89.4%。73例为皮下注射硼替佐米,43例接受静脉注射,皮下注射组感染发生率为78.1%,静脉注射组为93.0%,各组比较差异有统计学意义(P<0.05)。诱导期间医院感染发病率为83.6%(97例),其中第一疗程81例出现感染,3例外院治疗具体感染不详,实际感染发病率为71.7%(81/113);第二疗程感染发病率为56.6%(64/113);共98例患者完成三个疗程治疗,感染发病率为43.9%(43/98);共66例患者完成四个疗程治疗,感染发病率为28.8%(19/66)。随着疗程的推进,感染率呈下降趋势。感染的部位从高到低依次是呼吸系统、皮肤及黏膜、口腔及胃肠道、血液、泌尿道。化疗期间是否预防性应用抗真菌药物的两组患者临床诊断构成比较,差异无统计学意义(P=0.063)。结论诱导期间感染发病率极高,主要的感染部位是呼吸系统,临床医生与患者均需加强呼吸系统感染的防治。

ObjectiveTo explore the infection status and clinical characteristics of healthcare associated infection(HAI)in patients initially diagnosed with multiple myeloma(MM)during the induction period.MethodsClinical data of116patients diagnosed with MM and initially treated with PAD(bortezomib+adriamycin+dexamethasone)or PDD(bortezomib+liposome doxorubicin+dexamethasone)regimen in a hospital were collected,infection rates and clinical characteristics of patients during the induction therapy period were analyzed statistically.ResultsAmong116patients,69received PAD regimen,and47received PDD regimen,infection rates in two groups were79.7%and89.4%respectively;73patients received subcutaneous injection of bortezomib,43received intravenous injection of bortezomib,infection rates in subcutaneous injection group and intravenous injection group were78.1%and93.0%respectively,difference was statistically significant between two groups(P<0.05).During the induction period,HAI rate was83.6%(n=97),81patients developed infection during the first course,infection status of3patients were not clear due to therapy outside the hospital,the actual infection rate was71.7%(81/113);infection rate during the second course was56.6%(64/113);a total of98patients completed three therapy courses,infection rate was43.9%(43/98);66patients completed four therapy courses,infection rate was28.8%(19/66).With the increase of the therapy course,infection rate showed a downward trend.Infection sites from high to low were respiratory system,skin and mucosa,oral and gastrointestinal system,bloodstream,and urinary tract.Difference in constitute of clinical diagnosis between patients receiving and without receiving prophylactic antifungal agents during chemotherapy period was not statistically significant(P=0.063).ConclusionInfection rate is very high during induction period,the main infection site is respiratory system,clinicians and patients need to pay more attention to the prevention and treatment of respiratory system infection.