血液系统疾病合并气单胞菌血流感染患者的临床及实验室特征

Clinical features and laboratory data analysis of Aeromonas bacteremia with hematological diseases

目的分析患有血液系统疾病患者气单胞菌血流感染的临床及实验室特征,为该类患者气单胞菌感染的防治提供依据。方法回顾性分析中国医学科学院血液病医院2014年1月至2018年12月5年发生气单胞菌血症的血液系统疾病患者,收集患者临床感染特征、菌株耐药性、发生季节、治疗及转归情况等相关信息。结果共42例血液病患者发生气单胞菌血流感染,其中39例(92.9%)血流感染发生于粒细胞缺乏(粒缺)期,平均发热时间为4(1~27)d,22例(52.4%)患者症状仅为发热,6例(14.3%)伴消化道症状(腹痛、腹泻、恶心、上消化道出血),8例(19.0%)伴肺部感染,13例(31.0%)伴皮肤软组织感染。7例(16.7%)患者死亡,且均伴皮肤软组织感染。气单胞菌对碳青霉烯类抗菌药物的耐药率为68.3%~70.7%,而对头孢菌素类、喹诺酮类及氨基糖苷类抗菌药物的耐药率均小于10%。结论血液系统疾病合并气单胞菌血流感染主要发生在粒缺期,主要以发热为主,当伴有皮肤软组织感染时死亡率高。抗菌药物选择应依据药敏结果,避免使用碳青霉烯类抗菌药物。

Objective To investigate the clinical and laboratory features of Aeromonas bacteremia in patients with hematological diseases,and provide evidence for the prevention and treatment of Aeromonas infection.Methods A retrospective study of patients with bloodstream infection of Aeromonas in our hospital from January 2014 to December 2018 was carried out.The clinical characteristics,antimicrobial susceptibility,infection seasons,antimicrobial therapy and evolution were analyzed.Results A total of 42 patients with hematological diseases had Aeromonas bloodstream infection within 5 years.Among them,39 cases(92.9%)of bloodstream infection occurred in the stage of neutropenia.The median time of fever was 4(1-27)d,22(52.4%)patients only had fever,6(14.3%)with gastrointestinal symptoms(abdominal pain,diarrhea,nausea,upper gastrointestinal bleeding),8(19.0%)with pulmonary infection,13(31.0%)with skin and soft tissue infections.Seven patients(16.7%)died with skin and soft tissue infection.The resistance of Aeromonas to carbapenems was 68.3%-70.7%,while the resistance rate to cephalosporins,quinolones and aminoglycosides were less than 10%.Conclusions Aeromonas bacteremia in patients with hematological diseases mainly occur in the neutropenia stage,usually with symptom like fever.The mortality is increased when accompanied by skin and soft tissue infection.Antibiotic use should be based on susceptibility results,and avoid the use of carbapenems.