血液病患者合并血流感染74例临床分析

Clinical analysis of 74 cases of bloodstream infections in patients with hematological disease

目的对凉山州第一人民医院血液科血液病患者合并血流感染的病原学、耐药情况和患者预后危险因素进行分析,为临床防治感染提供依据,以期提高血流感染的治愈率。方法回顾性分析2015年1月1日-2019年12月31日该院血液病患者合并血流感染的细菌分布、耐药情况等临床资料,对预后相关因素进行分析,采用SPSS 22.0软件进行统计分析。结果该科74例患者血培养分离的74株菌株中,革兰阴性菌株52株,占70.3%,革兰阳性菌株19株,占25.7%,真菌3株,占4.1%。前五位致病菌分别为大肠埃希菌(39.2%)、肺炎克雷伯菌(14.9%)、金黄色葡萄球菌(6.8%)、屎肠球菌(4.1%)和阴沟肠杆菌(4.1%)。细菌耐药情况分析显示:革兰阴性菌耐药率较低,多对阿米卡星及含β内酰胺酶抑制剂的复合制剂敏感;革兰阳性菌中无明显耐药发生,但有1株屎肠球菌耐万古霉素。单因素分析卡方检验提示:病死率在不同年龄(P=0.015)、降钙素原(PCT)水平(P=0.015)、白蛋白水平(P=0.034)、合并基础疾病(P=0.006)中差异有统计学意义。logistic回归分析提示:合并基础疾病、血清PCT升高及白蛋白降低是该组血流感染患者28 d内死亡的独立预后危险因素。结论该院血液病合并血流感染的病原菌分布仍以革兰阴性菌为主,目前尚无严重耐药情况。治疗过程需密切关注患者的合并基础疾病情况、血清PCT及白蛋白水平,及时对患者的预后进行评估,调整治疗方案,以提高血流感染患者的治愈率。

Objective To analyze the distribution and antibiotic resistance profile of pathogens,and prognostic factors of bloodstream infections in patients with hematological disease for better clinical prevention and treatment of such infections.Methods A retrospective analysis was carried out with the clinical data of the hematological patients complicated with bloodstream infection who were treated in the First People's Hospital of Liangshan Prefecture from January 1,2015 to December 31,2019.SPSS 22.0 software was used for statistical analysis.Results The 74 strains isolated from blood samples of 74 patients in hematology department included 52(70.3%)strains of gram-negative bacteria,19(25.7%)strains of gram-positive bacteria,and 3(4.1%)strains of fungi.The top five pathogenic bacteria were Escherichia coli(39.2%),Klebsiella pneumoniae(14.9%),Staphylococcus aureus(6.8%),Enterococcus faecium(4.1%),and Enterobacter cloacae(4.1%).No significant antibiotic resistance was found in grampositive bacteria except one strain of vancomycin-resistant E.faecium.Gram-negative bacteria showed lower resistance level.Most strains were susceptible to amikacin and β-lactam/β-lactamase inhibitor combinations.Univariate analysis showed that age(P=0.015),procalcitonin(P=0.015),albumin level(P=0.034),and underlying diseases(P=0.006)had significant effect on patient mortality.Logistic regression analysis showed that elderly age,underlying diseases,elevated serum procalcitonin,and decreased albumin level were independent prognostic factors for 28-day death after bloodstream infection.Conclusions The bloodstream infections in patients with hematological diseases in this hospital are mainly caused by gram-negative bacteria.The causative pathogens do not show severe resistance.The clinicians should take patients age,underlying diseases,serum procalcitonin and albumin levels into account when assessing the prognosis of patients.