恶性血液病合并血流感染61例临床分析  

Clinical Analysis of 61 Cases of Malignant Hematology with Bloodstream Infection

作　　者：金凤波[1] 夏瑞祥[1] 金广霞[1] 吴炜[1] 刘飞[1] 

机构地区：[1]安徽医科大学第四附属医院,安徽合肥230000

出　　处：《国际输血及血液学杂志》2012年第3期201-205,共5页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨恶性血液病患者血流感染（BSI）的病原学特点、预后及治疗。方法对安徽医科大学第一附属医院院血液科2008年1月至2009年12月收治的61例恶性血液病合并BSI患者进行回顾性分析。计算患者送检血样中，72株非重复致病株对多种抗菌药物的耐药率及敏感度；并以“患者中性粒细胞、住院时间、年龄、初始抗菌药物治疗方案”4个方面为观察指标，考察恶性血液病合并BSI患者的感染的病原学特点及预后，并对观察指标中，定性资料采用X^2。检验、定量资料采用t检验进行相关统计学分析。于血培养结果回报前，对60例患者均采取经验性抗菌药物治疗。血培养结果反馈后，按照血培养结果进行处理，并采用t检验对抗菌药物平均治疗时间进行统计学评价。结果61例恶性血液病患者BSI主要病原菌为革兰阴性（G^-）菌。其中，产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌株检出率分别为56．25％和36．60％。产ESBLs大肠埃希菌对碳青霉烯类抗菌药物均敏感，产ESBLs肺炎克雷伯菌对亚胺培南的敏感度为100％。本组革兰阳性（G^＋）球菌对万古霉素及利奈唑胺的敏感度均为100％。中性粒细胞计数〈0．5×10^9／L患者较〉0．5×10^9／L患者多重感染发生率高（X^2=5．455，P=0．02）；住院时间〉20d患者较％20d患者多重感染发生率高（X^2=7．576，P=0．006）；年龄〉60岁患者较％60岁患者因感染所致病死率高（X^23．021，P=0．023）。60例患者中，35例经验性治疗与血培养药敏试验结果一致，继续原方案治疗，抗菌药物平均使用时间为（15．03±8．82）d；25例不一致，则采取及时换药处理，抗菌药物平均治疗时间为（25．16±12．86）d，两者抗菌药物平均治疗时间比较，差异有统计学意义（t=-3．623，P=0．022），而且经验性治疗与药敏试验结果一致患者的病死率Objective To study the characteristics, treatments and prognosis in the malignant hematology patients with bloodstream infection. Methods From January 2008 to December 2009, 61 cases of malignant hematology with bloodstream infection patients, who were treated by department of blood transfusion in the First Affiliated Hospital of Anhui Medical University, were analyzed retrospectively. The antibiotic resistance rates and sensitivity rates of 72 non-duplicate pathogenic isolates were calculated, and the infection related factors and prognosis of malignant hematology with bloodstream infection patients were analyzed, through the issues of patientsr neutrophil counts, days of hospitalization, age and initial antimicrobial treatment options. The 3（z test was used to analyze the qualitative data, and the t-test was used to analyze the quantitative data. P〈0.05 showed that the difference was statistically significant. Results The main pathogens of these 61 patients were Gram-negative bacterium. The total prevalence of extended- spectrum beta-lactamases （EBSLs）-producing strains in E. coli and Klebsiella isolates were 56. 25% and 36.60%, respectively. The sensitive rates of ESBLs-producing strains of E. coli to Imipenem, Klebsiella to Imipenem, and Gram-positive cocci to Vancomycin and Linezolid were 100%. Compared with the patients whose neutrophils〉0.5 × 10^9/L, the patients whose neutrophils〉0.5 × 10^9/L were more susceptible to multiple infection （X^2=5.455,P=0.02）. Among the 60 patients , the multiple infection was significant different between hospitalization days 〈20 d and 〉20 d（X^2 = 7. 576 ,P= 0. 006）. The mortality was high in patients over the age of 60（X^2= 3. 021,P= 0. 023）. Before the blood culture results returning, the antimicrobial treatment average times of the 35 patients who had used the antibiotics rightly [（15.03 ± 8.82） d] were longer than the 25 wrong ones E（25.16±12. 86） d] （t=-3.623,P=0.022）, and the mortality of the two groups was different （t=-3.

关 键 词：恶性血液病 血流感染 病原菌 

分 类 号：R446.5[医药卫生—诊断学]