急性白血病患者中性粒细胞缺乏伴发热的微生物特征

The microbial characteristics of neutropenia with fever in patients with acute leukemia

目的了解急性白血病患者中性粒细胞缺乏(简称粒缺)伴发热的临床特点和感染微生物特征.方法回顾性分析本院血液科住院治疗并发生粒缺的急性白血病成人患者的临床资料.结果粒缺伴发热139例次;粒缺持续时间>7d、极重度粒缺是粒缺伴发热的独立危险因素.不明原因发热(FUO)44例次(31.65%),临床证实感染(CDI)59例次(42.45%),微生物学证实感染(MDI)36例次(25.90%).培养阳性46株病原微生物中革兰阴性菌占76.09%,革兰阳性菌占4.35%和真菌占19.57%,37株细菌中共检出17株(45.95%)耐药菌株.粒缺伴发热总病死率11.76%,肺部感染与血流感染之间病死率,差异无统计学意义(P>0.05).结论粒缺伴发热是急性白血病治疗过程中常见合并症,粒缺持续时间>7d、极重度粒缺是粒缺伴发热的独立危险因素.呼吸道感染最为常见,病原微生物以革兰阴性菌为主,且耐药率高.了解此类患者的临床特征和病原微生物耐药特点对指导急性白血病粒缺伴发热患者的诊治具有重要临床意义.

Objective To investigate the clinical and microbial characteristic of neutropenia along with fever in acute leukemic patients.Methods Acute leukemic adult patients who developed neutropenia during hospitalization were analyzed by retrospecrive study.Results A total of 139 neutropenic febrile events occurred.Duration of neutropenia more than 7d and severe neutropenia were correlated with higher incidence of fever.The number of fever of unknown origin(FUO)was 44(31.65%),the number of clinical demonstrated infection(CDI)was 59(42.45%)and that of microbial demonstrated infection(MDI)was 36(25.90%).There were totally 46 pathogenic microorganisms,consisted of 76.09% Gram-negative bacteria,4.35% Gram-positive bacteria and 19.57% fungus.17 cases(45.95%)of resistant bacteria were detected in 37 cases of bacteria.Mortality of neutropenia along with fever in acute leukemic patients was 11.76%.No significance was found in mortality between pulmonary infection and blood stream infection(P>0.05).Conclusion Neutropenia along with fever is common complication in acute leukemic patients.Duration of neutropenia more than 7d and severe neutropenia are correlated with higher incidence of fever.Respiratory tract infection is most common.The main pathogenic microorganisms are Gram-negative bacteria,with high resistance rate.Understanding the clinic and microbial characteristic of neutropenia along with fever in acute leukemic patients is beneficial for diagnosis and treatment.