恶性血液病患者革兰阳性菌血流感染的影响因素及预后分析  

Prognosis of hematologic malignacies patients with grampositive bacteria bloodstream infection

作　　者：邓倩 唐亦舒 成倩[1] 曾惠奇 周天翊 李昕[1] DENG qian;TANG Yi-shu;CHENG qian;ZENG Hui-qi;ZHOU Tian-yi;LI Xin(The Third Xiangya Hospital of Central South University,Changsha,Hunan 410013,China)

机构地区：[1]中南大学湘雅三医院血液内科,湖南长沙410013

出　　处：《中华医院感染学杂志》2018年第24期3771-3775,3803,共6页Chinese Journal of Nosocomiology

基　　金：中南大学研究生教育教学改革基金资助项目(2016JGB20);中南大学研究生自主探索创新基金资助项目(2017zzts837)

摘　　要：目的探讨近年湖南地区恶性血液病患者革兰阳性细菌血流感染流行病学特征及其预后情况,为指导临床合理用药和采取干预措施提供理论依据。方法回顾性分析2013年1月-2018年4月湖南省三家大型附属教学医院血液科病房的恶性血液病患者的相关临床资料。对患者的临床特点、感染的病原菌分布特征和药物敏感情况及预后进行研究。采用SPSS 22.0软件进行统计分析。结果研究共纳入520例血流感染患者的标本,共119株革兰阳性菌,占22.9%;革兰阳性菌血流感染与疾病类型、合并肺炎相关;合并肺炎是革兰阳性菌血流感染的独立影响因素;以30天死亡率作为预后判定结果,Pitt评分>3分是影响恶性血液病合并革兰阳性菌血流感染患者的预后独立影响因素。结论早期恰当运用抗菌药物控制肺炎、改善呼吸循环和纠正低蛋白血症有助于减少革兰阳性菌血流感染及改善患者预后。OBJECTIVE To analyze and investigate the epidemiological characteristics and prognosis of gram-positive bacterial bloodstream infection in patients with hematologic malignancies in Hunan province in recent years,so as to provide a theoretical basis for guiding clinical rational use of drugs.METHODS The clinical data of patients with hematologic malignancies in three university-affiliated hospitals in Hunan Province,from Jan.2013 to Apr.2018, were retrospectively analyzed.The clinical characteristics of the patients,the species of pathogens,drug susceptibility,and prognosis were statistically analyzed,and the statistical analysis of data was performed using SPSS 22.0 software.RESULTS A total of 520 specimens of patients with bloodstream infections were included in the study. There were 119 strains of gram-positive bacteria,accounting for 22.9%.Gram-positive bacterial bloodstream infection was associated with disease types and pneumonia.Complication with pneumonia was an independent risk factor for bloodstream infection caused by gram-positive bacteria.Judging the prognosis with 30 day mortality, then the Pitt bacteremia score of >3 was an independent risk factor for the prognosis of patients with hematologic malignancies and Gram-positive bacterial bloodstream infection.CONCLUSION It is necessary to reasonably use antibiotics to control pneumonia,improve respiratory cycle function and correct hypoalbuminemia,so as to effectively reduce Gram-positive bacterial infection and improve prognosis.

关 键 词：血液系统恶性疾病 血流感染 革兰阳性菌 流行病学 预后 

分 类 号：R552[医药卫生—血液循环系统疾病]