恶性血液病合并血流感染患者病原学特征及预后因素分析

Analysis in pathogenic characteristics and prognostic factors in malignant hematopathy patients complicated with bloodstream infection

目的 分析恶性血液病患者血流感染的病原学、耐药情况及预后相关危险因素。方法 回顾性分析162例合并血流感染的恶性血液病患者的菌种分布、耐药情况等临床资料,以30 d病死率为主要终点确定影响预后的因素。结果 162例恶性血液病合并血流感染患者共分离出162株病原菌,包括革兰阴性菌112株(69.1%)、革兰阳性菌42株(25.9%)、真菌8株(4.9%)。在革兰阴性菌中排名前4位的为大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌及阴沟肠杆菌阴沟亚种;共发现耐碳青霉烯肠杆菌科8例次,其中耐碳青霉烯肺炎克雷伯杆菌占比最高。总30 d病死率为28.4%。Logistic回归分析显示,30 d病死率的独立预测因素包括疾病状态、粒缺持续时间、Pitt菌血症评分。结论 恶性血液病患者血流感染病原菌的种类较多,以革兰阴性菌为主;不同的病原菌对抗菌药物的敏感性不同,应根据本地区血流感染病原菌的分布及耐药情况合理使用抗菌药物。

Objective To analyze the etiology,drug resistance and prognosis⁃related risk factors of patients with malignant hematopathy.Methods The clinical materials such as bacteria distribution and drug resistance of 162 malignant hematopathy patients with bloodstream infection were analyzed retrospectively,and the 30⁃day mortality was used as the primary endpoint to determine the prognostic factors.Results A total of 162 strains of pathogenic bacteria were isolated from 162 malignant hema⁃topathy patients with bloodstream infection,including 112 strains of Gram⁃negative bacteria(69.1%),42 strains of Gram⁃positive bacteria(25.9%),and 8 strains of fungus(4.9%).Among the Gram⁃negative bacteria,the top four were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Enterobacter cloacae subspecies cloacae;a total of 8 cases with carbapenem⁃resistant Enterobacteriaceae were found,in which carbapenem⁃resistant Klebsiella pneumoniae accounted for the highest proportion.The total 30⁃day mortality was 28.4%.Logistic regression analysis showed that the independent predictors for 30⁃day mortality were disease status,duration of agranulocytosis and Pitt bacteremia score.Conclusion There are many kinds of pathogenic bacteria of bloodstream in⁃fection in patients with malignant hematopathy,and the Gram⁃negative bacilli is the main type;differ⁃ent pathogenic bacteria have different sensitivities to antibiotics,and antibiotics should be used rea⁃sonably according to the distribution and drug resistance of pathogenic bacteria of bloodstream infection in the region.