造血干细胞移植后早期细菌感染的临床分析

Clinical analysis of blood stream infection during early period after hematopoietic stem cell transplantation

目的:分析造血干细胞移植(HSCT)患者移植后早期(30d内)细菌感染的临床特点、病原菌分布等情况,为HSCT患者经验性治疗的选择提供依据。方法:回顾性分析我院305例HSCT患者,总结其移植后早期细菌感染的发生率、临床表现、病原菌分布及药敏试验结果。结果:305例患者中共计发生细菌感染256例(83.93%),其中68例(26.56%)患者移植前即发生感染,229例(89.45%)患者感染时处于粒缺期。256例发生细菌感染患者中,细菌培养阳性患者83例(32.42%),分离出致病菌106株,其中革兰氏阳性细菌52株(49.06%),革兰氏阴性细菌54株(50.94%)。致病菌前3位分别为大肠埃希菌30株(28.30%)、表皮葡萄球菌14株(13.21%)和肺炎克雷伯菌10株(9.43%),其中多重耐药菌41株。结论:我院HSCT患者移植后早期细菌感染以革兰氏阴性菌多见,革兰氏阳性菌和革兰氏阴性菌分别对于替加环素和亚胺培南耐药率最低,中性粒细胞和血小板植入时间≥14d是HSCT后发生细菌感染的危险因素。

Objective:To analyze the clinical features,pathogen distribution of bacterial infection during the early period after hematopoietic stem cell transplantation(HSCT),thus providing basis for empirical therapy of HSCT patients.Method:The clinical data of 305 cases of HSCT patients were retrospectively analyzed to identify the total occurrences of early bacterial infection,the patients’clinical features,the pathogens’distributions and the drug sensitive tests.Result:Among 305 HSCT patients,256 cases(83.93%)developed bacterial infection,in which68 cases(26.56%)endured infection prior of HSCT and 229 cases(89.45%)were in the period of agranulocytosis.Among the 256 patients who had bacterial infection,83 cases(32.42%)had positive bacteria culture results and 106 pathogens were identified,52 pathogens(49.06%)were gram positive bacterium,54 pathogens(50.94%)were gram negative bacterium.Escherichia coli(28.30%),Staphylococcus epidermidis(13.21%)and Klebsiella pneumoniae(9.43%)were listed the top three.Totally there were 41 multiple drug resistant pathogens.Conclusion:Among the pathogens isolated from patients who endured bacterial infection early period after HSCT,gram negative bacterium is more frequently seen.Gram positive bacterium and gram negative bacterium are most sensitive to Tigecycline and Imipenem,the engraftment time of neutrophil and platelet longer than 14 days are risk factors for the occurrence of bacterial infection.