急性白血病患者化疗后发生院内感染的临床特点

Analysis of Clinical Characteristics of Nosocomial Infection in Patients with Acute Leukemia after Chemotherapy

目的探讨急性白血病患者化学治疗后合并院内感染的危险因素和病原菌分布特点,从而更好地指导经验性抗感染治疗。方法以2016年1月至2018年12月湖北医药学院附属人民医院血液科210例急性白血病化疗后患者为研究对象,采用回顾性分析的方法对患者院内感染的发生部位、危险因素、病原菌分布、耐药情况及治疗转归等临床特点进行分析。结果210例急性白血病患者共接收化学治疗830例次,发生院内感染250例次,感染部位主要为呼吸道,其次为胃肠道及肛周、血液、皮肤及软组织等。单因素分析表明,年龄、住院时间、粒缺持续时间、疾病未缓解、中心静脉置管、伴发系统疾病、是否使用层流罩进行感染预防和糖皮质激素使用与院内感染有关(P<0.05)。多因素分析表明,中心静脉置管、粒细胞缺乏持续≥7 d、住院时间≥20 d、疾病未缓解为其独立危险因素(P<0.05)。院内感染病原学检查以革兰氏阴性杆菌为主,阳性率59.6%,其中病原菌以大肠埃希氏菌、铜绿假单胞菌和肺炎克雷伯菌为主;革兰氏阳性球菌占31.2%,以表皮葡萄球菌和金黄色葡萄球菌为主;真菌占9.2%,以白色假丝酵母菌为主。对革兰氏阴性杆菌敏感的抗生素有亚胺培南、美罗培南、头孢吡肟、头孢哌酮舒巴坦、哌拉西林他唑巴坦等,对阳性菌敏感的抗生素有万古霉素、利奈唑胺等,多重耐药菌阳性率22.9%,该250例次院内感染治疗的总体有效率96.0%。结论急性白血病患者化学治疗后院内感染发生率高,应结合本病区病原菌和耐药监测数据等临床特点,及时给予经验性的有效抗生素和防护措施,对于降低感染致死率具有重要意义。

Objective To explore the risk factors and pathogen distribution characteristics of nosocomial infection in patients with acute leukemia after chemotherapy to guide empirical anti-infection therapy better.Methods In the Department of Hematology of Affiliated Renmin Hospital of Hubei University of Medicine,210 patients with acute leukemia after chemotherapy who were treated here from January 2016 to December 2018 were selected as objects of study.Clinical characteristics such as the location,risk factors and pathogen distribution,drug resistance and treatment outcome of nosocomial infection were analyzed retrospectively.Results 210 patients with acute leukemia received chemotherapy for a total of 830 times and nosocomial infection occurred in 250 cases.The infection site was mainly respiratory tract,followed by gastrointestinal tract and anus,blood,skin and soft tissue.Single-factor analysis showed that age,length of hospital stay,duration of agranulocytosis,non-remission of the disease,central venous catheterization,concomitant systemic diseases,the use of laminar mask for infection prevention and glucocorticoid use were related to nosocomial infection(P<0.05).Multiple-factor analysis showed that central venous catheterization,agranulocytosis lasted for more than or equal to 7 days,length of hospital stay was more than or equal to 20 days,and non-remission of the disease were independent risk factors of nosocomial infection(P<0.05).The etiological examination was focused on Gram-negative bacteria whose positive rate was 59.6%,and Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were the main pathogens.Staphylococcus epidermidis and Staphylococcus aureus were the main pathogens of Gram-positive cocci which accounted for 31.2%.Candida albicans was the main pathogen of fungi which accounted for 9.2%.The antibiotics sensitive to Gram-negative bacilli were imipenem,meropenem,cefepime,cefoperazone sulbactam and piperacillin tazobactam,etc.Vancomycin and linazolam were sensitive to positive bacteria.The positive rate of multiple drug-resistant bacteria was 22.9%.The overall effective rate of the 250 cases with nosocomial infection was 96.0%.Conclusion The incidence of nosocomial infection in patients with acute leukemia after chemotherapy is high.According to the clinical characteristics such as pathogenic bacteria in this unit and drug resistance monitoring data in our hospital,empirical and effective antibiotics and protective measures should be given in time.It is of great significance to reduce the mortality rate of infection.