急性白血病患者医院感染病原菌分布及影响因素分析

Influencing factors for nosocomial infection in patients with acute leukemia and distribution of pathogens

目的研究急性白血病患者医院感染的临床特点、病原菌分布和影响因素。方法选取2013年12月-2017年2月医院收治的急性白血病患者274例作为研究对象,收集患者临床资料,分析感染患者的临床特点和病原菌分布,探究发生医院感染的影响因素。结果 274例急性白血病患者发生医院感染79例,感染率为28.83%,患者感染部位主要为呼吸道占44.30%,其次为消化道占11.39%;共检出82株病原菌,革兰阴性菌53株占64.63%,革兰阳性菌21株占25.61%,真菌8株占9.76%;单因素和多因素Logistic回归分析结果显示,住院天数、社区感染、应用免疫调节剂、进行化疗、中性粒细胞计数水平为患者发生医院感染的影响因素。结论急性白血病患者医院感染主要为呼吸道感染和消化道感染,感染主要病原菌为革兰阴性菌,患者发生医院感染的影响因素较多,临床工作中需采取针对性的干预措施进行防范,降低感染率。

OBJECTIVE To investigate the clinical characteristics and influencing factors for nosocomial infection in the patients with acute leukemia and analyze the distribution of pathogens.METHODS A total of 274 patients with acute leukemia who were treated in the hospital from Dec 2013 to Feb 2017 were recruited as the study objects,the clinical data were collected from the patients,the clinical characteristics of the patients with infection and the distribution of pathogens were observed,and the influencing factors for the nosocomial infection were explored.RESULTS Of the 274 patients with acute leukemia,79 had nosocomial infection,with the infection rate 28.83%,44.30%of whom had respiratory tract infection,and 11.39%had gastrointestinal tract infection.Totally 82 strains of pathogens were isolated,53(64.63%)of which were gram-negative bacteria,21(25.61%)were gram-positive bacteria,and 8(9.76%)were fungi.The results of univariate and multivariate logistic regression analysis showed that the length of hospital stay,community-associated infection,use of immunomodulators,chemotherapy and neutrophils counts were the influencing factors for the nosocomial infection.CONCLUSION The patients with respiratory tract infection and gastrointestinal tract infection are dominant among the patients with acute leukemia,the gram-negative bacteria are the predominant pathogens causing the infection.There are a variety of influencing factors for the nosocomial infection,and it is necessary to take targeted intervention measures during clinical practice so as to reduce the infection rate.