血液肿瘤患者血流感染病原菌分布特点及危险因素研究

Etiological analysis of bloodstream infections and its risk factors in patients with hematological malignancies

目的分析血液肿瘤患者血流感染(bloodstream infection,BSI)病原菌分布和耐药特点,探讨发生BSI的危险因素。方法选取2013年1月至2018年6月,江苏大学附属昆山医院血液肿瘤住院患者344例,抽取患者8~10ml外周静脉血进行病原菌培养,应用多因素logistic回归分析方法分析血培养阳性的危险因素。结果107例发生BSI的血液肿瘤患者血液样本共分离出112株病原菌,其中革兰阴性菌61株(54.47%),革兰阳性菌36株(32.14%),真菌15株(13.39%)。多因素logistic回归分析显示,年龄≥60岁[OR(95%CI)=3.63(1.10~10.02)];有侵入性操作[OR(95%CI)=2.12(1.12~11.14)];粒细胞缺乏≥7d[OR(95%CI)=2.45(1.14~9.85)]和有其他部位感染[OR(95%CI)=1.75(1.21~12.24)]是血液肿瘤患者发生BSI的危险因素。结论血液肿瘤患者BSI病原菌主要以革兰阴性菌为主,病原菌耐药情况不容忽视。应从年龄、侵入性操作、粒细胞缺乏以及其他部位感染等方面来预防血液肿瘤患者发生BSI。

Objective To analyze the distribution and drug-resistant features of pathogens causing bloodstream infections(BSI)in patients with hematological malignancies and explore the risk factors for BSI.Methods A total of 344patients with hematological malignancies in Kunshan Hospital Affiliated to Jiangsu Umiversity were enrolled in the study from January 2013to June 2018,and 8~10ml blood specimens were collected and cultured.Multivariate logistic regression method was used for risk factors analysis.Results A total of 112 strains of pathogens were isolated,including 61strains of gram-negative bacteria(54.47%),36strains of gram-positive bacteria(32.14%)and 15strains of fungus(13.39%)in 107patients with hematological malignancies and BSI.Logistic analysis showed that patients aged 60and older(OR=3.63,95%CI:1.10~10.02),with invasive operation(OR=2.12,95%CI:1.12~11.14),having agranulocytosis for 7days and longer(OR=2.45,95%CI:1.14~9.85)and with other infections(OR=1.75,95%CI:1.21~12.24)were more likely to have BSI.Conclusions The gram-negative bacteria are the predominant pathogens causing BSI in patients with hematological malignancies.Comprehensive interventions should be adopted based on patient′s age,invasive procedures,neutropenia,and other infections.