中性粒细胞缺乏的白血病患者并发多重耐药菌感染的危险因素分析

Risk factors analysis of multidrug-resistant organism infection in leukemia patients with neutrophil deficiency

目的分析中性粒细胞缺乏的白血病患者感染多重耐药菌的危险因素,并为其有效防控提供对策。方法收集362例次白血病患者临床资料,分析患者的临床特点、样本来源及多重耐药菌感染的病原菌构成及患者预后,并对是否感染多重耐药菌进行危险因素分析,提出防控对策。结果共有47例次(13.0%)患者感染多重耐药菌,检出样本中,痰液及血液的比例最高,分别为21例次(44.7%)及9例次(19.1%);在多重耐药菌的分布构成中,耐甲氧西林凝固酶阴性葡萄球菌检出率最高,占40.4%;32例次(68.1%)多重耐药菌感染患者好转出院。单因素分析显示,患者住院次数≥6次、发热、造血干细胞移植后、留置引流管及既往感染过多重耐药菌5个变量是患者多重耐药菌感染的危险因素。Logistic回归分析结果显示,造血干细胞移植后、留置引流管及既往感染过多重耐药菌是中性粒细胞缺乏患者多重耐药菌感染的独立危险因素。结论中性粒细胞缺乏的白血病患者感染的多重耐药菌种类较多,多从痰液及血液中检出,且以耐甲氧西林凝固酶阴性葡萄球菌为主,总体预后较好;中性粒细胞缺乏的白血病患者感染多重耐药菌的危险因素较多,医护人员应加强监测与筛查,制定综合感染控制措施,以有效防止耐药菌的流行和传播,改善患者的预后。

Objective To analyze the risk factors of infection of multidrug-resistant organism in leukemia patients with neutrophil deficiency and provide countermeasures for its effective prevention and control.Methods Clinical data of 362 cases of leukemia with neutrophil deficiency from January to December 2020 were collected.The clinical characteristics,sample source,pathogen composition,the outcomes of multidrug-resistant organism infection and the risk factors of multidrug resistant organism were analyzed.Results A total of 47 cases(13.0%)were infected with multidrug-resistant organism.The sputum(21,44.7%)and blood infections(9,19.1%)were the highest in the all detected samples.The methicillin-resistant coagulase negative staphylococci was the most common infection(40.4%)among all detected multidrug-resistant organism.Thirty-two patients(68.1%)with multiple-resistant organism infection received improvement and discharged.Univariate analysis showed that frequent hospitalizations(≥6),fever,hematopoietic stem cell transplantation,indwelling drainage tube and previous infection of multidrug-resistant organism were the risk factors for multidrug-resistant organism infection.Logistic regression analysis showed that hematopoietic stem cell transplantation,indwelling drainage tube and previous infection with multidrug-resistant organism were independent risk factors for multidrug-resistant organism infection in patients with neutrophil deficiency.Conclusion There are many kinds of multidrug-resistant organism in leukemia patients with neutrophil deficiency,which were mostly detected from sputum and blood,and mainly with methicillin-resistant coagulase negative Staphylococcus.The outcomes of patients are quite good.There are many risk factors for multidrug-resistant organism in leukemia patients with neutrophil deficiency,so surveillance and screening should be strengthened,and comprehensive infection control measures should be developed to effectively prevent the prevalence and transmission of drug-resistant bacteria and improve the outcomes of patients.