血液病粒细胞缺乏患者医院血流感染的回顾性临床分析  

Nosocomial bloodstream infections in neutropenic hematological patients: a retrospective clinical study

作　　者：汤丽苑[1] 俞康[1] 

机构地区：[1]温州医学院附属第一医院血液科,浙江温州325000

出　　处：《中华医院感染学杂志》2012年第23期5241-5243,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析血液病粒细胞缺乏患者血流感染的危险因素、病原菌分布及耐药性,为减少其血流感染的发病率及病死率提供依据。方法对医院2009-2011年61例血液科粒细胞缺乏患者并发医院血流感染进行回顾性临床分析。结果免疫抑制剂应用、中性粒细胞<0.2×109/L、中性粒细胞缺乏时间<7d及癌症支持疗法多国学会风险指数<21分是血液病粒细胞缺乏患者医院血流感染的危险因素,其OR值分别为6.967、28.306、4.383、69.002;共检出62株病原菌,其中革兰阴性菌、革兰阳性菌、真菌分别占64.5%、27.4%、8.1%,最常见的病原菌为大肠埃希菌、肺炎克雷伯菌及金黄色葡萄球菌,分别占30.6%、21.0%及8.1%;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别为47.4%和30.8%。结论针对各种危险因素采用有效的应对措施,可减少血液病粒细胞缺乏患者血流感染的发病率和病死率。OBJECTIVE To investigate the risk factors of nosocomial bloodstream infections in hematological patients with neutropenia,and analyze the distribution and antibiotic resistance of the pathogenic bacteria so as to provide basis for reduling the in cidence of blood stream infections and the mortality. METHODS A retrospective analysis of neutropenic patients with nosocomial bloodstream infections was performed from 2009 to 2011. RESULTS 1 ： 2 matched case-control study showed the immunosuppressive therapy（OR= 6. 967） ,neutrophil〈0.2 × 10^9/L（OR = 28. 306）, the duration of neutropenia〈 7 days （OR = 4. 383）, MASCC risk index〈 21 scores （Multinational Association of Supportive Care of Cancer risk index score, OR：69. 002） were important risk factors of nosocomial bloodstream infections in hematological patients with neutropenia; of totally 62 strains of pathogens isolated, gram-negative bacteria accounted for 64. 5%. gram-positive bacteria accounted for 27.4%, and fungi accounted for 8.1 %, the most common pathogenic organisms identified were Escherichia coli （30.6% ）, Klebsiella pneumoniae （21. 0%） and Staphylococcus aureus （8. 1%）; the detection rates of ESBLs-producing strains of E. coli and K. pneumoniae were 47.4% and 30.8%, respectively. CONCLUSION It is critical to take effective measures and monitor the local bacterial epidemiology to control or decrease the morbidity and mortality of nosocomial bloodstream infections in hematological patients with neutropenia.

关 键 词：血液病 粒细胞缺乏 血流感染 病原菌 耐药性 

分 类 号：R181.32[医药卫生—流行病学]