急性白血病患者化疗后下呼吸道大肠埃希菌感染的危险因素分析

Analysis on risk factors for lower respiratory tract Escherichia coli infection in patients with acute leukemia after chemotherapy

目的探讨急性白血病患者化疗后下呼吸道大肠埃希菌感染的相关危险因素,为制定临床策略提供有力的依据。方法收集2016年6月至2018年5月首都医科大学宣武医院收治的急性白血病患者2 136例,发生下呼吸道感染的患者共501例,培养出大肠埃希菌的患者共83例,对其资料进行回顾性分析,包括基础疾病与急性生理与慢性健康标准Ⅱ评分(APACHEⅡ)、手卫生、血清白蛋白、呼吸机使用、贫血比率、联合使用抗生素、留置尿管等。结果急性白血病患者化疗后下呼吸道大肠埃希菌感染的发生率为16. 6%(83/501),单因素分析显示,感染组与非感染组患者APACHEⅡ评分、贫血比率、手卫生、血清白蛋白、呼吸机的使用、联合使用抗生素差异均具有统计学意义(P <0. 05)。多因素非条件Logistic回归分析显示,APACHEⅡ评分、手卫生、联合使用抗生素为急性白血病患者化疗后下呼吸道大肠埃希菌感染的独立危险因素。结论治疗原发病、改善患者体质、注意手卫生、减少抗菌药物联合使用能够明显减少急性白血病患者化疗后下呼吸道大肠埃希菌感染。

Objective To explore the risk factors of lower respiratory tract Escherichia coli infection in patients with acute leukemia after chemotherapy,and to provide a strong basis for clinical strategies.Methods A total of 2 009 patients with acute leukemia were admitted to Xuanwu Hospital,Capital Medical University during June 2016 to May 2018.Among them,501 patients suffered with lower respiratory tract infection and Escherichia coli had been cultured fromb 83 patients.The data were retrospectively analyzed,including basic disease and acute physiology and chronic health scoring standards(APACHEⅡ),hand hygiene,serum albumin,ventilator use,anemia ratio,indwelling catheter,etc.Results The incidence of lower respiratory tract Escherichia coli infection in patients with acute leukemia after chemotherapy was 16.6%(83/501).Univariate analysis showed that APACHEⅡscores,anemia rate,hand hygiene,serum level of albumin,application of ventilator and combination use of antibiotics had statistical significance(P<0.05).Multivariate unconditional Logistic regression analysis showed that APACHEⅡscores,hand hygiene and combined use of antibiotics were independent risk factors for lower respiratory tract Escherichia coli infection in patients with acute leukemia after chemotherapy.Conclusion The treatment of primary diseases,improvement of patients’physique,attention to hand hygiene and reduce the combination use of antibiotics can significantly reduce lower respiratory tract Escherichia coli infection in patients with acute leukemia after chemotherapy.