恶性血液病患者化学治疗后并发医院感染153例临床分析  

Clinical analysis of nosocomial infection in 153 patients with hematologic malignancies after chemotherapy

作　　者：王莉华[1] 吴隼[1] 黄琰[1] 郭燕[1] 武金日 贺立山[1] 

机构地区：[1]新乡医学院第一附属医院血液科,河南卫辉453100

出　　处：《新乡医学院学报》2015年第3期252-255,共4页Journal of Xinxiang Medical University

摘　　要：目的研究恶性血液病患者化学治疗后并发医院感染的临床特点。方法回顾性分析2013年1月至2014年6月新乡医学院第一附属医院153例恶性血液病患者化学治疗后发生医院感染的部位、病原菌分布、耐药性及感染的易感因素。结果 142例患者处于化学治疗后粒细胞缺乏及减少状态;感染部位以呼吸道感染为主(56.21%),其次为血液感染;病原菌中细菌感染占93.22%,真菌感染占6.78%;对革兰阴性杆菌较为敏感的药物为美罗培南、亚胺培南及阿米卡星;对革兰阳性球菌较为敏感的药物为替考拉宁、利奈唑胺及万古霉素;对真菌较为敏感的药物为制霉菌素和两性霉素B,细菌和真菌均出现不同程度的耐药;粒细胞数目、年龄及住院时间为医院感染的易感因素(P<0.05)。结论恶性血液病化学治疗后粒细胞缺乏及减少的患者医院感染发生率较高,以革兰阴性杆菌感染为主,通过感染特点分析对临床抗感染治疗有积极的作用。Objective To investigate the characteristic of nosocomial infection in patients with hematologic malignancies after chemotherapy. Methods The data of 153 patients with hematologic malignancies were analyzed retrospectively including infection location,the distribution of pathogens,the drug resistance of pathogenic bacteria and predisposing factors of infection after chemotherapy. Results There were 142 cases undergoing the state of lack and reduction in granulocyte after chemotherapy. The main infection was respiratory infections（ 56. 21%）,followed by blood infections. In the distribution of pathogens,bacterial infection accounted for 93. 22%,fungal infection accounted for 6. 78%. Meropenem,imipenem and amikacin were sensitive for Gram-negative bacteria,and teicoplanin,linezolid and vancomycin were susceptive for Gram-positive bacteria. Nystatin and amphotericin B were subtle drugs against fungus. It was found that there were different levels of drug resistance on bacteria and fungus. The neutrophil counts,hospitalization days and age were the predisposing factors in the analysis of infection（ P 0. 05）. Conclusion There is a high nosocomial infectious rate in the patients with hematologic malignancies,who are underwent the state of lack and reduction in granulocyte after chemotherapy. The main common infection is Gram-negative bacteria. It has a positive effect on future clinical anti-infection treatment by the means of the analysis of the infectious characteristics.

关 键 词：恶性血液病 化学治疗 医院感染 病原菌 

分 类 号：R781.62[医药卫生—口腔医学]