淋巴肿瘤患者细菌性血流感染临床和细菌学分析  

Clinical and bacteriological analysis of lymphoid tissue neoplasms patients with bacteria bloodstream infections

作　　者：王婷玉 李增军 林青松 苏东 吕瑞 邓书会 隋伟薇 傅明伟 黄文阳 刘薇 刘宏 邱录贵 

机构地区：[1]中国医学科学院、北京协和医学院血液学研究所、血液病医院,实验血液学国家重点实验室,天津300020

出　　处：《中华血液学杂志》2017年第12期1043-1048,共6页Chinese Journal of Hematology

基　　金：天津市应用基础与前沿技术研究计划（15JCYBJC27900）

摘　　要：目的探讨淋巴肿瘤患者细菌性血流感染的临床特征和细菌学及药敏结果，为抗感染治疗选择提供参考。方法回顾性分析2010年9月至2014年12月发生细菌性血流感染淋巴肿瘤患者的临床资料和细菌药敏试验结果。结果共107例患者发生134例次血流感染，其中粒细胞缺乏112例次，106例次为严重粒细胞缺乏（ANC〈0．1×10^9／L）。原发病治疗方案包括：造血干细胞移植27例次；化疗100例次[33例次采用VD（I）CP＋L方案（长春新碱＋柔红霉素／去甲氧柔红霉素＋环磷酰胺＋泼尼松士左旋门冬酰胺酶），41例次采用Hyper—CVAD／MA或MA（米托蒽醌＋阿糖胞苷）强化疗方案，26例次采用其他化疗方案]；未化疗7例次。10例患者放弃治疗出院，120例次患者感染控制好转，2例患者死于脓毒血症，1例患者心源性猝死，1例患者死于移植物抗宿主病。共分离出病原菌144株，其中革兰阴性菌108株（75．0％），革兰阳性菌36株（25．0％）。革兰阴性菌对碳青霉烯类抗生素敏感率为98．00％，治疗调整率为3．0％；对非碳青霉烯类抗菌药物敏感率为60．30％，治疗调整率为90．5％。革兰阳性菌对碳青霉烯类抗生素敏感率为49．3％，对万古霉素或替考拉宁、利奈唑胺敏感率为i00．0％。将所有经验性用药与血培养药敏结果比照，80．1％初始用药即为敏感药物。结论发生血流感染的淋巴肿瘤患者以急性淋巴细胞白血病样方案化疗后最常见。致病细菌以革兰阴性菌多见。药敏试验显示革兰阴性菌对碳青霉烯类抗生素敏感性最高，治疗调整率更低。革兰阳性菌对糖肽类抗菌药物、利奈唑胺敏感性高。Objective To investigate the clinical status of lymphoid tissue neoplasms patients with bacteria bloodstream infections, bacteriology and drug susceptibility results, and provide the basis for rational clinical anti-infection option. Methods A retrospectively analysis of clinical data and bacterial susceptibility test results of patients with bacteria bloodstream infections from September 2010 to December 2014 was conducted. Results A total of 134 cases including 107 patients with bloodstream infections were enrolled. 84 cases were male, 50 cases were female, the median age was 31 （ 12-71 ） years old. 112 cases were agranulocytosis, and 106 cases were severe agranulocytosis （ANC 〈 0.1 x 109/L）. 27 cases underwent hematopoietic stem cell transplantation, 100 cases received chemotherapy [33 cases with VD （I） CP ± L （vincristine ＋ daunorubicin / idarubicin ＋ cyclophosphamide ＋ prednison ± asparaginasum） induction chemotherapy, 41 cases with intensive chemotherapy of Hyper-CVAD/MA or MA （mitoxantrone＋ cytarabine）, 26 cases with other chemotherapy regimens], and 7 cases were infected without chemotherapy. 10 patients discharged from hospital owing to treatment abandoning, 120 cases were cured through anti-infective therapy, 2 patients died of bacteria bloodstream infections, 1 patient died of sudden cardiac, and l patient died of GVHD after allogenic hematopoietic stem cell transplantation. A total of 144 strains were isolated, including 108 strains （75.0%） of Gram-negative bacteria and 36 strains （25.0%） of Gram-positive cocci. The susceptibility of Gram-negative bacteria to the carbapenems was 98.00%, and the adjustment treatment rate of carbapenems was 3.0%. The susceptibility of Gram-negative bacteria to the other antibiotics was 60.30%, and the adjustment treatment rate was 90.5%. The susceptibility of Gram- positive cocci to the carbapenems was 49.3%, and to glycopeptides and linezolid was 100.0%, Comparing all patients＇ empirical use of antimicrobial agents with the dru

关 键 词：淋巴系统疾病 血流感染 细菌感染 

分 类 号：R733.1[医药卫生—肿瘤]