急性白血病患者化疗后血流感染病原菌分布及危险因素分析  

Pathogen distribution and risk factors of post-chemotherapy bloodstream infection in patients with acute leukemia

作　　者：朱齐兵 陈慧君[1] 唐小万[2] 江文华[2] 陈莉莉[2] 叶发青 

机构地区：[1]浙江省台州市第一人民医院临床药学室,318020 [2]浙江省台州市第一人民医院血液肿瘤科,318020 [3]温州医科大学药学院,325035

出　　处：《中国医药》2018年第1期104-107,共4页China Medicine

基　　金：浙江省自然科学基金(LY16B020010)~~

摘　　要：目的分析急性白血病(AL)患者化疗后血流感染病原菌分布特点及相关危险因素,为AL感染预防治疗提供参考。方法回顾性分析2012年1月至2016年12月浙江省台州市第一人民医院血液肿瘤科收治的260例AL化疗患者临床资料,分析患者化疗后血流感染的发生情况及病原菌构成比,对导致血流感染的危险因素实施单因素分析和多因素Logistic回归分析。结果 260例化疗患者中发生血流感染33例,感染发生率12.7%;共分离出病原菌36株,其中革兰阳性菌9株(占25.0%),革兰阴性菌26株(占72.2%),真菌1株(占2.8%);革兰阳性菌中以表皮葡萄球菌为主,占11.1%(4/36),革兰阴性菌中以大肠埃希菌为主,占30.6%(11/36)。单因素分析显示,住院天数、化疗阶段、合并糖尿病、中性粒细胞缺乏持续时间与血流感染的发生具有相关性(P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病(β值=1.388,比值比=4.005,P=0.038)和中性粒细胞缺乏持续时间>7 d(β值=1.752,比值比=5.769,P<0.001)是AL患者化疗后发生血流感染的独立危险因素。结论导致AL患者化疗后发生血流感染的病原菌以革兰阴性菌为主,感染的发生与合并糖尿病、中性粒细胞缺乏持续时间等因素密切相关,临床治疗时需加强患者的风险评估,及早干预,严密监控并预防感染的发生。Objective To analyze pathogen features and risk factors of post-chemotherapy bloodstream infection ＇in patients with acute leukemia（AL）. Methods Clinical data of 260 AL patients who had chemotherapy from January 2012 to December 2016 in Department of Hematology and Oncology, Taizhou First People＇s Hospital were reviewed.＂ Occurrence of bloodstream infection and features of pathogen distribution were recorded. Risk factors of bloodstream infection were analyzed by logistic regression. Results Bloodstream infection occurred in 33 patients（ 12. 7% ）. Thirty-six pathogens were isolated, including 9 strains（25.0% ） of gram-positive bacteria, 26 strains （ 72. 2% ） of gram-negative bacteria and 1 strain （ 2. 8% ） of fungi; staphylococcus epidermidis was 11.1% （4/36） in gram-positive bacteria; escherichia coli was 30. 6% （11/36） in gram-negative bacteria. Univariate analysis showed that length of hospital stay, stage of chemotherapy, diabetes and duration of neutropenia were related to occurrence of bloodstream infection （ P 〈 0. 05 ）. Multivariate logistic regression analysis showed that diabetes（β = 1. 388, odds ratio =4. 005, P=0. 038） and duration of neutropenia 〉7 d（β = 1. 752, odds ratio = 5.769, P 〈 0. 001） were independent risk factors of bloodstream infection. Conclusions Gram-negative bacteria are dominant among pathogens causing bloodstream infection in AL patients after chemotherapy. Incidence of bloodstream infection is closely associated with diabetes and duration of neutropenia.

关 键 词：急性白血病 血流感染 危险因素 预防措施 

分 类 号：R733.71[医药卫生—肿瘤]