急性白血病中性粒细胞减少患者应用喹诺酮类药物预防感染的临床研究  

Clinical study on fluoroquinolone prophylaxis in neutropenia patients with acute leukemia

作　　者：秦铁军[1] 秘营昌[1] 冯四洲[1] 李大鹏[1] 魏嘉璘[1] 杨栋林[1] 韩明哲[1] 王建祥[1] 卞寿庚[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所,天津300020

出　　处：《中华医学杂志》2007年第20期1389-1393,共5页National Medical Journal of China

摘　　要：目的探讨急性白血病患者中性粒细胞减少期常规口服喹诺酮类药物预防感染的影响。方法309例发生感染的急性白血病住院患者，中性粒细胞减少期常规口服喹诺酮类药物预防细菌感染149例（A组），无喹诺酮预防感染160例（B组）。回顾性分析两组患者的菌群流行病学特征及敏感性、发生感染的临床特征，研究喹诺酮类药物预防性应用的影响。结果两组患者均存在严重的中性粒细胞减少，中性粒细胞绝对值（ANC）〈0．2×10^9／L持续中位时间为11（0～43）d。中位发热天数为8（1～46）d。喹诺酮类药物的预防应用使正常菌群显著减少（P=0．00），大肠杆菌的比例明显增加（P=0．00），其他主要致病菌的菌群分布无明显区别。喹诺酮预防病区和非喹诺酮预防病区的大肠杆菌超广谱β内酰胺酶（ESBL）阳性率无明显区别（分别为31．9％、35．4％，P=0．61）。两组间大部分抗生素的敏感性没有区别。喹诺酮预防组患者上呼吸道感染／扁桃腺炎的发生率（10．7％）减少，消化道感染相对比例（14．4％）增加。喹诺酮类药物的预防性应用并不能降低败血症的发生率（分别为14．0％、14．7％，P=0．86）。A、B两组患者的初始经验性抗感染治疗的初步有效率分别为65．8％、60．6％（P=0．35），最终有效率分别为96．0％、91．9％（P=0．14），喹诺酮类药物的预防性应用对抗感染治疗没有负面作用。结论急性白血病中性粒细胞减少患者预防性应用喹诺酮类药物影响菌群分布，正常菌群比例明显减少，而大肠杆菌比例相应增加，其他菌群比例无明显变化。常规的抗生素预防没有增加主要致病菌的耐药性。预防性口服喹诺酮类药物不能减少消化道感染及败血症发生。Objective To investigate the chnical benefits and the impacts on distribution and antibiotic resistance of pathogenic bacterium associated with fluoroquinolone prophylaxis during neutropenia in patients with acute leukemia. Methods A total of 309 infection episodes occurred in patients with acute leukemia were retrospectively analyzed. The patients admitted in ward A （group A, n = 149） received oral ofloxacin as antibacterial prophylaxis during the neutropenia phase; no antibacterial prophylaxis was administered to the patients in ward B （group B, n = 160）. The influences of prophylactic ofloxacin were determined by comparative evaluation on the clinical characteristics and the microbiological profile in both groups＇ patients. Results Almost all enrolled patients experienced severe neutropenia. The median durations of ANC （absolute neutrophil count, ANC） 〈0.2 × 10^9/L were 11 （range 0 -43） days. The median persistence time of fever was 8 （ range 1 - 46） days. Prophylaxis of ofloxacin decreased the proportion of normal flora （ P = 0. 00 ） . The frequency of Escherichia coli was higher in group A than group B （23.9%, 12. 5%, respectively, P =0. 00）. Exposure to ofloxacin didn＇t affect the distributions of other pathogenic bacteria. No difference in the rate of ESBL （ ＋ ） Escherichia coli was discovered between ofloxacin and no ofloxacin prophylaxis groups （31.9% , 35.4% , respectively, P =0. 61 ）. Commonly used antibiotics had similar activity against the major strains isolated from two groups. Patients who received antibacterial prophylaxis showed a lower incidence （ 10. 7% ） of upper respiratory infections/tonsillitis and a relative higher incidence （14.4%） of gastrointestinal tract infections than those without intervention measure. The prophylactic use of ofloxacin couldn＇t cut down the risk of septicemia. Ofloxacin prophylaxis did not display negative effect on initial clinical response （65.8% in group A, 60. 6% in group B, respectively, P =0. 35） and

关 键 词：白血病 中性粒细胞减少 喹诺酮类 感染 

分 类 号：R733.71[医药卫生—肿瘤]