儿童恶性血液病并发血流感染病原学与临床特征

Pathogensis and clinical characteristics of bloodstream infection in children with hematological malignancies

目的 探讨儿童恶性血液病血流感染的临床特点、病原学特征、细菌的耐药性及炎症指标变化,为预防及治疗血流感染提供依据。方法 回顾性分析2020年6月-2022年6月武汉儿童医院97例血流感染恶性血液病患儿的临床资料、实验室检测结果以及病原菌分布和药物敏感性数据。结果 女童38例,男童59例,年龄分布4个月~15岁;42.27%为急性淋巴细胞白血病,29.90%为急性髓系白血病;70.10%患儿处于粒缺状态,73.20%患儿有留置中心静脉管;革兰阳性菌感染占53.40%,以凝固酶阴性葡萄球菌(CNS)和链球菌属为主;肠杆菌目细菌中头孢曲松的耐药率为55.00%,阿米卡星及替加环素100.00%敏感,其中9株大肠埃希菌对碳青霉烯类的抗菌药物均敏感,13例肺炎克雷伯菌感染患儿中,耐碳青霉烯类抗菌药物菌株有2例。革兰阳性菌中凝固酶阴性葡萄球菌、链球菌属和金黄色葡萄球菌对万古霉素、利奈唑胺和替考拉宁的敏感率均为100.00%,凝固酶阴性葡萄球菌对青霉素、红霉素、苯唑西林耐药率分别为90.91%、86.36%和90.91%,草绿色链球菌中青霉素耐药率33.33%;革兰阴性菌组血流感染患儿血清降钙素原(PCT)和白细胞介素-6(IL-6)水平高于革兰阳性菌感染组(P<0.05)。结论 凝固酶阴性葡萄球菌,肠杆菌目及草绿色链球菌为恶性血液病儿童血流感染常见菌,病原菌药敏结果发布前使用利奈唑胺、万古霉素及碳青霉烯类抗菌药物可用于抗血流感染经验性预防用药;临床需加强患儿皮肤黏膜护理及集束化导管护理措施,有利于降低血流感染的发生。

OBJECTIVE To investigate the clinical features,etiological characteristics,bacterial resistance and changes in inflammatory indicators of bloodstream infections in children with hematologic malignancies,so as to provide a basis for the prevention and effective treatment of bloodstream infections.METHODS The clinical data,laboratory test results,bacterial distribution and antibiotic susceptibility data of 97 children diagnosed as bloodstream infections in children with hematologic malignancies in Wuhan Children′s Hospital during Jun.2020 to Jun.2022 were retrospectively analyzed.RESULTS There were 59 boys and 38 girls,aged 4 months to 15 years.42.27% were diagnosed with acute lymphoblastic leukaemia,29.90% were diagnosed with acute myeloid leukaemia.70.10% of the children were in the state of agranulocytosis.Central venous catheters were indwelled in 73.20% of children.Gram-positive bacterial infection accounted for 53.40%,mainly included Coagulase negative Staphylococcus(CNS) and Streptococcus;The drug resistance rate of ceftriaxone in Enterobacteriaceae was 55.00%,and amikacin and tigecycline were 100.00% sensitive.Among them,9 strains of Escherichia coli were sensitive to carbapenems.Among 13 children infected with Klebsiella pneumoniae,2 strains were carbapenems resistant.The sensitivity rates of coagulase negative Staphylococcus,Streptococcus and Staphylococcus aureus in gram positive bacteria to vancomycin,linezolid and teicoplanin were all 100.00%,the resistance rates of coagulase negative Staphylococcus to penicillin,erythromycin and oxacillin were 90.91%,86.36% and 90.91%,respectively,and the resistance rate of penicillin in grass green Streptococcus was 33.33%.The levels of serum PCT and IL-6 in the children with gram-negative bacterial bloodstream infection were significantly higher than those infected with the gram-positive bacteria.CONCLUSION Coagulase-negative Staphylococcus(CNS),Enterobacteriaceae and Streptococcus viridis were the common bacteria for bloodstream infections in children with hematologic malignancies.Linezolid,vancomycin and carbapenems could be used for empirical prophylactic drugs against bloodstream infection before the release of pathogenic drug sensitivity results.Clinical measures concerning the care of skin and mucous membrane and cluster catheter care should be enhanced to help reduce the incidence of bloodstream infection.