较低危骨髓增生异常综合征并发感染的临床分析  

Clinical analysis of lower-risk myelodysplastic syndrome complicated with infection

作　　者：陈蔚[1] 姚晖[2] 周瑛[3] 胡慧菁[4] 陆瑛[5] 卫英[1] 叶成林[6] 姚永华[6] 

机构地区：[1]上海市杨浦区市东医院药剂科,上海200438 [2]上海市杨浦区市东医院放疗科,上海200438 [3]上海市杨浦区市东医院老年科,上海200438 [4]上海市杨浦区市东医院中医科,上海200438 [5]上海市杨浦区市东医院院感科,上海2004386 [6]上海市杨浦区市东医院血液科,上海200438

出　　处：《中国临床医学》2016年第3期350-353,共4页Chinese Journal of Clinical Medicine

基　　金：上海市卫生和计划生育委员会重大项目课题(201540032);上海市综合医院中西医结合专项(ZHYY-ZXYJHZX-2-19);上海市杨浦区卫计委课题(201304)~~

摘　　要：目的:了解较低危骨髓增生异常综合征(myelodysplastic syndrome,MDS)患者并发感染的临床特点。方法:回顾分析2013年1月至2015年9月入院治疗的53例较低危MDS患者的临床资料。结果:53例较低危MDS患者中,38例发生感染(共59次),以肺部、泌尿系统感染居多(74.6%,44/59)。泌尿系统感染中,老年女性患者发生率高(82.4%,14/17)。病原菌检出率前3位分别为大肠埃希菌、肺炎克雷伯菌、粪肠球菌,其中50%大肠埃希菌、14.3%肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)。粪肠球菌对常用抗生素耐药率低。较低危MDS患者中血细胞减少伴多系发育异常(RCMD)、外周血细胞三系减少、合并心脑血管疾病者感染发生率高(P<0.05)。结论:较低危MDS患者易并发感染,以肺部、泌尿系统感染居多。较低危MDS患者抗感染治疗需考虑临床分型、外周血计数、合并基础疾病等危险因素,建议结合病原学检测及细菌耐药检测结果选择抗生素。Objective：To investigate the clinical characteristics of lower-risk myelodysplastic syndrome（MDS）complicated with infection.Methods：The clinical data of 53 patients with lower-risk MDS admitted to hospital from January2013 to September 2015 were analyzed retrospectively.Results：Among 53 cases of lower-risk MDS patients,38 cases were infected（59times）,mostly lung and urinary system infections（74.6%,44/59）.Incidence of urinary tract infections was high in elderly women（82.4%,14/17）.The top 3pathogenic bacteria were Escherichia coli（50% ESBLs＋）,Klebsiella pneumonia（14.3% ESBLs＋）and enterococcus faecalis.The resistance rate of enterococcus faecalis to commonly used antibiotics was low.In lower-risk MDS patients,the rate of infection was high in those with refractory cytopenia with multilineage dysplasia（RCMD）,in those whose three types of peripheral blood cells decreased,and in those combined with cardiovascular diseases（P〈0.05）.Conclusions：Lower-risk MDS patients are easy to be complicated with infections,mostly lung and urinary system infections.In their anti-infection treatment,the risk factors such as clinical classification,peripheral blood count,combination with basic underlying diseases should be considered.It is suggested that antibiotics should be selected in combination with pathogen detection and bacterial drug resistance detection results.

关 键 词：骨髓增生异常综合征 较低危 感染 细菌耐药 

分 类 号：R551.3[医药卫生—血液循环系统疾病]