造血干细胞移植后血流感染的临床分析

Clinical Analysis of Bloodstream Infection after Hematopoietic Stem Cell Transplantation

目的:分析造血干细胞移植(HSCT)患者血流感染的临床特征。方法:回顾性分析2013年1月至2020年6月在我科行HSCT的910例患者的临床特征、发生血流感染的病原菌分布及药敏情况。结果:910例患者中,111例在移植后100 d内确诊血流感染,98例的血流感染发生在粒细胞缺乏(粒缺)期。多因素分析显示,预处理方案含抗胸腺细胞球蛋白(ATG)、粒缺持续时间长、单个核细胞(MNC)输注量低是HSCT后血流感染的独立危险因素。分离出的121株病原菌中,革兰氏阴性(G^(-))菌76株(62.8%),革兰氏阳性(G^(+))菌40株(33.1%),真菌5株(4.1%)。病原菌前3位依次为大肠埃希菌、表皮葡萄球菌和铜绿假单胞菌。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对碳青霉烯类药物耐药率分别为14.3%、7.7%和66.7%。G^(+)菌对万古霉素、利奈唑胺、替考拉宁的敏感率分别为97.5%、100%和100%。血流感染患者HSCT后100 d死亡率显著高于无血流感染患者(P<0.001)。结论:预处理方案含ATG、粒缺持续时间长、MNC输注量低是HSCT后血流感染的独立危险因素,移植后血流感染病原菌以革兰氏阴性菌多见,铜绿假单胞菌对碳青霉烯类药物耐药率高。

Objective:To analyze the clinical characteristics of bloodstream infection(BSI)in patients treated by hematopoietic stem cell transplantation(HSCT).Methods:The clinical characteristics,distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed.Results:Among 910 HSCT patients,111 patients were diagnosed as BSI within 100 days after transplantation,and 98 patients showed BSI during the period of agranulocytosis.Multivariate analysis showed that the usage of anti-thymocyte globulin(ATG),long duration of agranulocytosis and low infusion volume of mononuclear cell(MNC)were the independent risk factors affecting BSI after HSCT.Among 121 pathogenic bacteria isolated,76 Gram-negative(G^(-))bacteria(62.8%),40 Gram-positive(G^(+))bacteria(33.0%),and 5 fungi(4.1%)were detected out.The top three pathogens were Escherichia coli,Staphylococcus epidermidis and Pseudomonas aeruginosa.The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3%and 7.7%,respectively,and Pseudomonas aeruginosa was 66.7%.The susceptibility of G^(+)bacteria to vancomycin,linezolid and teicoplanin was 97.5%,100%and100%,respectively.The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI(P<0.001).Conclusion:The usage of ATG,long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT.The pathogens after HSCT are mainly G^(-)bacteria.Pseudomonas aeruginosa is highly resistant to carbapenems.