急性白血病患者气单胞菌败血症的临床特征和转归分析  

The Clinical Features and Prognosis of Aeromonas Septicaemia in Patients with Acute Leukemia

作　　者：李大鹏 刘庆珍 苏东 李增军 邹德慧 

机构地区：[1]中国医学科学院血液病医院,天津300020

出　　处：《中国医药指南》2013年第15期4-6,共3页Guide of China Medicine

摘　　要：目的加强对急性白血病患者气单胞菌属败血症的认识,为临床估计病情及治疗选择提供依据。方法回顾性总结2002年至2009年发生于我院（位于中国华北地区）血液系统疾患的气单胞菌属败血症患者,分析其流行病学、临床表现、病原微生物学和治疗转归等。结果 8年间共16例,均为急性白血病患者。以男性为主,发病季节以夏秋季（5~10月）为主（87.5%）。所有患者均为院内感染,无聚集、流行性发病趋势。菌种包含嗜水气单胞菌和温和气单胞菌,以后者（68.8%）占优势;其中6例（37.5%）伴随其他病原菌败血症,均为温和气单胞菌败血症的患者。所有患者近期或正在接受细胞毒药物化疗,发生败血症时都处于重度中性粒细胞减少。临床表现缺乏特异性,最常见的是寒战、发热（100%）,仅有5例（31.3%）患者之前伴随腹泻,4例（25%）并发休克。常见伴发的感染部位包括皮肤软组织感染/蜂窝组织炎（37.5%）、肛周感染（31.3%）、肺感染（25.0%）等。药敏结果对除外青霉素类的绝大多数β内酰胺类抗生素敏感,未见碳青霉烯和氨基糖苷类抗生素耐药。患者均及时接受了敏感抗生素抗感染治疗,病死率仍较高（31.3%）。死亡者发生于起病3~4d内,均为温和气单胞菌同时伴随其他病原菌败血症,多并发休克同时伴随其他部位严重感染如蜂窝组织炎、肺部感染或腹膜炎等。结论气单胞菌败血症虽不常见于北方地区,但多于夏秋季发生于化疗后中性粒细胞减少的急性白血病患者。除青霉素类的β内酰胺类抗生素对绝大多数气单胞菌敏感。温和气单胞菌的致病力更强,应注意复杂感染的预防和早期治疗。Objective To specifically recognized the clinical features ofAeromonas septicaemia in the patients with acute leukemia, and to provide a basis for estimates of clinical conditions and treatment options. Methods From 2002 to 2009, all patients suffered from Aeromonas septicaemia with hematologic diseases in our hospital（in northern of China） were included for the retrospective study. We analysed the demographic, clinical and microbiologic characteristics, treatment and prognosis in these patients. Results During the 8-year period,16 patients with acute leukemia developed Aeromonas septicaemia. The majority of them were males（12 ： 4）. All of the infection was nosocomial, and Aeromonas septicaemia generally occurred in summer or fa11（87.5%）. No cluster ofAeromonas septicaemia was found during the study period. The isolates speciated comprised Aeromonas sobria and A.hydrophila, and A. sobria was the most common species, six （24.4%） episodes of septicaemia were polymicrobial, and in the patients ofA. sobria septicaemia. All of patients recent had received or underwent antineoplastic chemotherapy, and were in severe neutropenia at the onset of septicaemia. The main clinical manifestations were fever and chill （100%）,followed by diarrhea（31.3% ）,septic shock （25%）, and so on. The most severa secondary infections were skin soft-tissue infections/cellulitis（37.5%）, anorectal infections（31.3%） and pneumonia（25.0%）.Most of 13 lactam agents（excluding penicillins） had high activity against the isolated strains. All patients received timely treatment of sensitive antibiotics. However, five （31.3%） patients died within 3 to 4 days of onset of septicaemia. A.sobria polymicrobial septicaemia complicated by septic shock and accompanied by other severe infections was the high risk factor for mortality. Conclusion Aeromonas septicaemia is uncommon in the northern of China but can occur in summer or fall, and develop particularly in the patients with acute leukemia. Chemotherapy and n

关 键 词：败血症 气单胞菌属 急性白血病 

分 类 号：R733.71[医药卫生—肿瘤]