【摘要】：目的探討惡性血液病合并血流感染的病原學(xué)及臨床特征,指導(dǎo)臨床治療。方法分析北京大學(xué)第三醫(yī)院血液科2011年9月至2016年9月血培養(yǎng)陽性的惡性血液病合并血流感染患者的臨床表現(xiàn)、治療及預(yù)后,并對分離細(xì)菌進(jìn)行鑒定及耐藥分析。結(jié)果 92例患者中64.1%發(fā)生血流感染時為粒細(xì)胞缺乏,所有患者均有發(fā)熱,45.7%發(fā)生感染中毒性休克,82.6%檢測到降鈣素原升高。檢出107株病原體,其中革蘭陰性菌75株(70.1%),革蘭陽性菌27株(25.2%),真菌5株(4.7%)。藥敏顯示:大腸埃希菌對頭孢曲松和左氧氟沙星耐藥率最高,達(dá)80.9%和91.3%;肺炎克雷伯菌和鮑曼不動桿菌對亞胺培南有較高的耐藥率,分別為31.2%和50.0%;革蘭陽性菌對萬古霉素及利奈唑胺尚敏感。92例患者死亡35例(38.0%),初始經(jīng)驗(yàn)治療抗生素是否有作用對預(yù)后有顯著影響(P0.05),經(jīng)驗(yàn)治療采用碳青霉烯類抗生素組的病死率略低于非碳青霉烯類治療組(28.6%對46.2%),但差異無統(tǒng)計(jì)學(xué)意義(P=0.163)。結(jié)論惡性血液病患者合并血流感染預(yù)后較差,致病原以革蘭陰性菌為主,耐藥發(fā)生率較高,對碳青霉烯類抗生素的耐藥性應(yīng)引起關(guān)注。初始經(jīng)驗(yàn)治療的有效性可顯著影響預(yù)后。
[Abstract]:Objective to investigate the etiology and clinical features of malignant hematopathy complicated with blood stream infection and to guide clinical treatment. Methods from September 2011 to September 2016, the clinical manifestations, treatment and prognosis of patients with hematologic malignancy complicated with hematological infection were analyzed. The isolated bacteria were identified and drug resistance was analyzed. Results granulocyte deficiency was found in 64.1% of the 92 patients. 45.7% of the patients had fever and 45.7% of the patients had toxic shock and 82.6% had increased procalcitonin. Among the 107 pathogens, 75 (70.1%) were Gram-negative bacteria, 27 (25.2%) Gram-positive bacteria and 5 (4.7%) fungi. The susceptibility of Escherichia coli to ceftriaxone and levofloxacin was 80.9% and 91.3%, and Klebsiella pneumoniae and Acinetobacter baumannii had high resistance to imipenem. Gram-positive bacteria were sensitive to vancomycin and linazolamide in 35 patients (38.0%). The effect of initial experience therapy on the prognosis was significant (P0.05), and carbapenem antibiotics were used in empirical therapy. The fatality rate in group A was slightly lower than that in group B (28.6% vs 46.2%), but the difference was not statistically significant (P = 0.163). Conclusion the prognosis of blood stream infection in patients with malignant hematologic diseases is poor. Gram-negative bacteria are the main pathogenic bacteria and the incidence of drug resistance is high. The resistance to carbapenem antibiotics should be paid attention to. The effectiveness of initial empirical therapy can significantly affect the prognosis.
【作者單位】： 北京大學(xué)第三醫(yī)院血液科;
【分類號】：R730.43;R733

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