免疫低下宿主败血症160例临床分析  

The clinical analysis of 160 immunocompromised hosts with septicaemia

作　　者：陈延斌[1] 黄建安[1] 凌春华[1] 雷伟[1] 陶岳多[1] 何广胜[2] 

机构地区：[1]苏州大学附属第一医院呼吸科,江苏苏州215006 [2]苏州大学附属第一医院血液科

出　　处：《中国呼吸与危重监护杂志》2008年第1期30-34,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：苏州大学附属第一医院优秀青年骨干基金(编号:QG05002)

摘　　要：目的探讨免疫低下宿主败血症的病原谱和临床特征。方法回顾性分析160例免疫低下宿主败血症患者的基础疾病、外周血粒细胞计数、血培养时的体温、治疗及转归。结果160例患者中,8例发生2次败血症,3例为复数菌败血症,共检出病原体171株;其中革兰阳性球菌37株(21.6%)、革兰阳性杆菌6株(3.5%)、革兰阴性杆菌113株(66.1%)、真菌l5株(8.8%)。革兰阳性球菌以葡萄球菌属和链球菌属为主,分别为17株和14株;革兰阳性杆菌以棒状杆菌属为主,有5株;革兰阴性杆菌中以大肠埃希菌、肺炎克雷白杆菌和铜绿假单胞菌多见,分别为60株、20株和15株。17株葡萄球菌中,金黄色葡萄球菌有12株,均对甲氧西林敏感(MSSA);113株革兰阴性杆菌中有20株产超广谱β-内酰胺酶(ESBLs),分别为大肠埃希菌17株、肺炎克雷白杆菌2株和产酸克雷白杆菌1株。真菌败血症均由念珠菌属感染所致,白色念珠菌4株、非白色念珠菌11株。中性粒细胞减少者120例(75%),其中103例为粒细胞缺乏症(粒缺)患者。70%的败血症患者出现高热。所有患者均接受了广谱抗生素治疗,58.8%的患者同时采取了抗真菌治疗。死亡20例,19例因病情恶化而放弃治疗,治愈好转率为75.6%。结论免疫低下宿主败血症中,细菌感染是首要病因,真菌的检出率呈上升趋势,粒缺是败血症发生的危险因素之一,高热是其重要体征。Objective To explore the pathogens and clinical features ofi hosts with septicaemia, Methods The data including underlying diseases, peripheral blood granulocyte count,temperature at blood sampling, management and prognosis of 160 immunocompromised hosts with septicaemia were analyzed retrospectively. Results 8 patients had twice septicaemia in hospital stay and 3 patients had plural pathogenic septicaemia. 171 strains of microorganisms were isolated from blood culture of 160 septic immunocompromised hosts in which 156 strains（91.2% ）were bacteria,37 strains（21,6% ） were gram positive cocci, 6 strains （ 3.5% ） were gram positive bacilli, 113 strains （66. 1% ） were gram negative bacilli and 15 strains（ 8.8 % ）were fungi. Staphylococcus spp（ 17 strains ）and Streptococcus spp（ 14 strains） were the predominant pathogens among gram positive cocci and Corynebacteria（5 strains ）were the main pathogen in gram positive bacilli while Escherichia coli （ 60 strains ）, Klebsiella pneumoniae （ 20 strains） and Pseudomonas aeruginosa（ 15 strains）were the most common bacteria in gram negative bacilli. There were 12 strains of Staphylococcus aureus among the 17 strains of Staphylococcus spp,all of them were methicillin sensitive（MSSA）. 17 strains of Escherichia coli,2 strains of Klebsiella pneumoniae and 1 strain of Klebsiella oxytoca produced ESBLs. Candida was the only pathogens of fungemia in this study in which 4 strains of Candida albicans and 11 strains of non-albicans Candida were detected. There were 120 patients （75%）with granulocytopenia in which 103 patients were agranulocytosis. 70% of the 160 paitents had hyperpyrexia. All patients received broad spectrum antibiotics therapy in the study while 58.8% received antifungal drugs at the same time. 20 patients died of septicaemia and 19 patients gave up therapy because of their conditions deteriorated. The overall improvement rate were 75.6%. Conclusions Bacteria are the main pathogens in septicaemia of immunoeompromised h

关 键 词：败血症 免疫功能低下 细菌 真菌 

分 类 号：R515.3[医药卫生—内科学] R519[医药卫生—临床医学]