急性白血病患者合并血流感染的临床特点分析

Clinical characteristics of acute leukemia patients complicated with blood flow infection

目的探讨急性白血病患者合并血流感染的临床特点和病原菌分布,为临床合理使用抗生素提供依据。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110例急性白血病合并血流感染患者为研究对象,对患者血流感染的临床特点、病原菌分布、耐药情况及治疗转归等进行回顾性分析。结果所有患者均有发热,部分血流感染患者合并有其他部位感染。急性白血病未缓解组与缓解组发热持续时间差异有统计学意义[(9.7±7.8)d vs.(5.2±3.7)d,P=0.015]。粒细胞缺乏组与非粒细胞缺乏组和粒细胞缺乏持续时间≥7 d组和<7 d组发热持续时间差异有统计学意义[(13.5±10.2)d vs.(6.1±5.0)d,P=0.001;(6.7±4.9)d vs.(4.9±2.8)d,P=0.030]。110例急性白血病患者共送检标本390份,共培养到阳性菌株119株,其中革兰氏阴性杆菌占61.3%,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30.3%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌和表皮葡萄球菌为主;真菌占8.4%,以白色假丝酵母菌为主。多重耐药菌阳性率27.7%,该110例患者血流感染治疗的总体有效率91.8%。结论血流感染是急性白血病患者常合并的一种严重感染并发症,革兰氏阴性杆菌仍是本病区血流感染的主要致病菌。原发病未缓解、粒细胞缺乏及其持续时间≥7 d为急性白血病合并血流感染的主要预后不良危险因素。

【Objective】To investigate the clinical characteristics and distribution of pathogenic bacteria in patients with acute leukemia accompanied with blood flow infection,and to provide the basis for rational use of antibiotics.【Methods】A total of 110 patients with acute leukemia accompanied with blood flow infection were studied in the department of hematology,the Affiliated People’s Hospital of Hubei University of Medicine from January 2016 to December 2018.The clinical characteristics of blood flow infection,the distribution of pathogenic bacteria,drug resistance and treatment outcome were retrospectively analyzed.【Results】All patients had fever,partial patients with blood flow infection were complicated with other site infections.There was significant difference in the duration of fever between non-remission group and remission group of acute leukemia[(9.7±7.8)d vs.(5.2±3.7)d,P=0.015].There was significant difference in the duration of fever between granulocyte deficiency group and non-granulocyte deficiency group and between the duration of neutropenia≥7 days group and<7 days group[(13.5±10.2)d vs.(6.1±5.0)d,P=0.001;(6.7±4.9)d vs.(4.9±2.8)d,P=0.030].In the 110 cases of acute leukemia,there were 390 cases of blood culture,and 119 samples were positive.Gram-negative bacilli accounted for 61.3%,among which the pathogenic bacteria were mainly Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae,and Gram-positive cocci accounted for 30.3%,mainly Staphylococcus aureus,coagulase negative Staphylococcus and Staphylococcus epidermidis;the fungus accounts for 8.4%,and is mainly Candida albicans.The positive rate of multiple drug-resistant bacteria was 27.7%.The overall effective rate of the 110 cases of blood flow infection was 91.8%.【Conclusion】Blood flow infection is a serious infection complication in patients with acute leukemia.Gram-negative bacilli is the main pathogen of blood flow infection in this ward.Unalleviated primary disease,granulocytosis and its duration≥7 days are poor prognostic risk factors for acute leukemia complicated with blood flow infection.