恶性血液病粒细胞缺乏症患者医院感染的临床特征及危险因素分析

Clinical Features of Nosocomial Infections in Agranulocytosis Patients with Hematological Malignancies and Analysis of Risk Factors

目的:探讨恶性血液病粒细胞缺乏症患者医院感染的临床特征及危险因素,为临床预防及治疗医院感染提供依据。方法:回顾性分析2015年5月至2018年5月兰州大学第一医院住院的725例恶性血液病粒细胞缺乏症患者的临床资料:性别、年龄、原发病、治疗阶段、粒细胞缺乏程度、粒细胞缺乏持续时间、医院感染、感染部位、平均住院时间、平均感染天数、接受放化疗、疾病缓解情况及病原学等。采用单因素χ^2检验和多因素非条件Logistic回归模型对医院感染相关危险因素进行分析。结果:恶性血液病粒细胞缺乏症患者医院感染最常见的部位是上呼吸道,占24.0%,其次是肺和血流,分别占16.2%和13.8%;医院感染的原发病中急性白血病占首位,感染率为82.1%,其中急性髓系白血病感染率最高(73.3%),其次是急性淋巴细胞白血病(68.0%)和多发性骨髓瘤(66.7%);急性白血病在初始诱导期及复发难治期感染率较高,分别为79.3%和84.5%。临床共分离出184株病原菌,其中革兰阴性菌126株占68.48%,革兰阳性菌23株占12.50%,真菌35株占19.02%。单因素分析发现,年龄、原发病、粒细胞缺乏程度及持续时间、化疗、使用糖皮质激素、疾病状态均与医院感染相关(P<0.05);多因素非条件Logistic回归分析表明,急性白血病、中性粒细胞绝对值<0.2×10^9/L、化疗及疾病未缓解是医院感染的主要危险因素。结论:恶性血液病粒细胞缺乏症患者是医院感染的高危人群,目前医院感染率仍较高,尤其急性白血病接受化疗或未获得完全缓解以及中性粒细胞绝对值<0.2×10^9/L的患者,应早期采取干预措施,以降低医院感染发生率及病死率。

Objective:To explore the clinical features and risk factors for nosocomial infections in agranulocytosis patients with hematological malignancies so as to provide basis for clinical prevention and treatment of nosocomial infections.Methods:The clinical data of 725 patients with agranulocytosis in the First Hospital of Lanzhou University from May 2015 to May 2018 were retrospectively analyzed,including sex,age,primary disease,treatment stage,agranulocytosis degree,agranulocytosis duration,nosocomial infection,infectous site,average length of stay and average days of infection.Univariate analysis(Chi-square test)and multivariate analysis(non-conditional Logistic regression models)were used to analyze the risk factors of nosocomial infection.Results:The most common sites of nosocomial infection in agranulocytosis patients with hematological maliguancies were upper respiratory tract,accounting for 24.0%,followed by lung(16.2%)and blood stream(13.8%).In disease composition,acute leukemia holded the first place,accounting for 82.1%,among which the acute myeloid leukemia had the highest infection rate,accounting for 73.3%,followed by acute lymphoblastic leukemia.The infection rates were 68.0%and 66.7%for multiple myeloma,79.3%and84.5%for acute leukemia at the initial induction and relapse stages,respectively.184 pathogenic bacteria were isolated clinically,of which 126 were a Gram-negative bacteria,23 were Gram-positive bacteria and 35 were fungi,accounting for 68.48%,12.50%and 19.02%,respectively.It was found that age,primary disease,degree and duration of granulocyte deficiency,chemotherapy,glucocorticoid use and disease status all associated with nosocomial infection(P<0.05).Multivariate unconditional logistic regression analysis showed that acute leukemia,absolute count of neutrophils<0.2×10^9/L,chemotherapy and disease unremitting were the main risk factors of nosocomial infection.Conclusion:The patients with malignant hematological agranulocytosis are a high-risk population of nosocomial infection.Nosocomial infection rate is still high,especially in patients with acute leukemia who have received chemotherapy or without complete remission or neutrophil absolute count less than 0.2×10^9/L.Thus early intervention measures should be taken to reduce the incidence of nosocomial infection and mortality.