肠道CRE筛查在恶性血液病患者治疗中的价值  

Value of intestinal CRE screening in the treatment of patients with hematologic malignancies

作　　者：叶萤燕 吴海英 蒋玉霞 洪飘如 苏传勇[2] 陶叠宏[2] 蒋慧芳[2] YE Yingyan;WU Haiying;JIANG Yuxia(School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]浙江省立同德医院血液科

出　　处：《全科医学临床与教育》2021年第3期224-227,共4页Clinical Education of General Practice

基　　金：浙江省公益基金(QY19H080001);浙江中西医结合血液病重点专科。

摘　　要：目的评价肠道耐碳青霉烯类肠杆菌科细菌(CRE)主动筛查在恶性血液病患者治疗过程中预防和控制耐碳青霉烯类肺炎克雷伯杆菌(CRKP)感染的效果,为预防与治疗CRKP败血症提供科学依据。方法回顾性收集恶性血液病治疗患者并行CRE肛拭子共601人次,评估CRE筛查的阳性率。选取其中发生肺炎克雷伯杆菌败血症的患者,将CRE筛查阳性的患者作为观察组,CRE筛查阴性的患者作为对照组。分析化疗后患者免疫力低下时引起的肺炎克雷伯杆菌败血症与CRE的相关性及早期多药联合经验性抗感染对患者的治疗效果。结果本次研究共进行肠道CRE筛查601人次,从肛拭子中检出CRE阳性次数≥1次的患者共109例,CRE阳性率为18.14%(109/601)。研究期间发生肺炎克雷伯杆菌败血症患者共18例,其中CRKP败血症共15例,占83.33%(15/18),死亡率达40.00%(6/15)。肺炎克雷伯杆菌败血症患者中CRE筛查阳性患者12例,败血症抢救成功率为66.67%(8/12),CRE筛查阳性患者发生CRKP败血症的概率为100%(12/12);CRE筛查阴性患者6例,败血症抢救成功率为33.33%(2/6),CRE筛查阴性患者发生CRKP败血症的概率为50.00%(3/6)。观察组中24 h内予以多药联合治疗组的患者死亡率明显低于单药治疗组,差异有统计学意义(P<0.05)。结论CRE定植患者发生CRKP败血症机率高,且死亡率高,采取肠道CRE筛查及早期多药联合抗感染能够有效降低医院感染CRKP败血症死亡率,提高抢救成功率。Objective To evaluate the effect of active screening of intestinal carbapenem-resistant Enterobacteriaceae(CRE)on the prevention and control of infection of carbapenem-resistant Klebsiella pneumoniae(CRKP)in patients with hematologic malignancies,and to provide scientific reference for the prevention and treatment of CRKP septicemia.Methods A total of 601 patients with hematologic malignancies who received CRE anal swab were collected retrospectively and the positive rate of CRE screening was evaluated.Patients with Klebsiella pneumoniae sepsis were selected,and the patients with positive CRE screening in Klebsiella pneumoniae sepsis patients were enrolled as observation group,and patients with negative CRE screening were enrolled as control group.The correlation between Klebsiella pneumoniae sepsis caused by poor immunity after chemotherapy and CRE was analyzed,and the therapeutic effect of early multi-drug combined with empirical anti-infection on patients was analyzed.Results Totally 601 people were screened for intestinal CRE,and 109 patients were detected positively for more than one time from anal swab.The positive rate of CRE was 18.14%(109/601).There were 18 patients with Klebsiella pneumoniae septicemia found in 601 patients,including 15 patients with CRKP septicemia,which accounting for 83.33%(15/18),and the mortality rate was 40.00%(6/15).Among the Klebsiella pneumoniae septicemia patients,12 patients were CRE positive.The success rate of rescue was 66.67%(8/12),and the probability of CRKP septicemia was 100%(12/12).The other 6 patients were CRE negative,the success rate of rescue was 33.33%(2/6),and the probability of CRKP septicemia was 50.00%(3/6).In the observation group,the mortality in the multi drug combined treatment group was significantly lower than that in the single drug treatment group within 24 hours,and the difference was statistically significant(P<0.05).Conclusion CRE implantation patients have a high incidence of CRKP septicemia and high mortality.Intestinal CRE screening and early mu

关 键 词：耐碳青霉烯类肠杆菌科细菌 肠道筛查 恶性血液病 败血症 

分 类 号：R733[医药卫生—肿瘤]