急性白血病并发革兰阴性菌血流感染病原菌及其危险因素

Pathogens isolated from acute leukemia patients complicated with gram-negative bacteria bloodstream infection and risk factors

目的分析急性白血病革兰阴性菌血流感染患者主要病原菌构成及感染危险因素。方法回顾性收集2018年3月-2022年3月黄冈市中心医院收治的179例急性白血病患者的临床资料,根据患者发病后10 d是否发生革兰阴性菌血流感染情况分为革兰阴性菌血流感染组(70例)和无革兰阴性菌血流感染组(109例)。统计急性白血病革兰阴性菌血流感染患者革兰阴性菌分布情况,另采用单因素及多因素Logistic回归分析急性白血病患者革兰阴性菌血流感染的危险因素。结果革兰阴性菌血流感染组患者的痰液样本中共分离出70株革兰阴性菌:肠杆菌41株(58.57%),非发酵菌23株(32.86%),其他6株(8.57%)。多因素结果显示,不合理使用抗菌药物、住院时间>30 d、合并肛周疾病、中性粒细胞缺乏持续时间≥7 d、血清清蛋白<35 g/L、血红蛋白水平<30 g/L、白细胞计数<4×10^(9)/L均为影响急性白血病患者革兰阴性菌血流感染的危险因素,差异有统计学意义(均P<0.05)。结论临床可据影响急性白血病患者革兰阴性菌血流感染的各项危险因素进行针对性治疗及干预,以降低患者革兰阴性菌血流感染率,改善预后。

OBJECTIVE To analyze the main pathogenic bacteria composition and risk factors in acute leukemia patients with gram-negative bacteria bloodstream infection.METHODS Clinical data of 179 patients with acute leukemia admitted to Huanggang Central Hospital from Mar 2018 to Mar 2022 were retrospectively collected.According to whether gram-negative bacteria bloodstream infection occurred 10 days after the onset of the disease,the patients were divided into the gram-negative bacteria bloodstream infection group(70 cases)and non-gram-negative bacteria bloodstream infection group(109 cases).The distribution of gram-negative bacteria in patients with acute leukemia complicated with gram-negative bacteria bloodstream infection was analyzed.The risk factors for gram-negative bacteria bloodstream infection in patients with acute leukemia were analyzed by univariate and multivariate logistic regression.RESULTS A total of 70 strains of gram-negative bacteria were isolated from sputum samples of patients with blood flow infection,including 41 strains(58.57%)of Enterobacteriaceae,23 strains(32.86%)of non-fermenting bacteria,and 6 strains(8.57%)of others.The multivariate logistic regression analysis showed that irrational use of antibiotics,hospital stay 30 d,combined perianal disease,arteriovenous intubation,blood transfusion,neutropenia duration≥7 d,serum albumin <35 g/L,hemoglobin level>30 g/L,and white blood cell count<4×10^(9)/L were all risk factors for gram-negative bacteria bloodstream infection in acute leukemia patients,and the differences were significant(all P<0.05).CONCLUSION Clinical treatment and intervention can be carried out according to the risk factors affecting gram-negative bacteria bloodstream infection in patients with acute leukemia,so as to reduce the infection rate of gram-negative bacteria bloodstream and improve the prognosis.