异基因造血干细胞移植患者血流感染病原菌谱及耐药性--单中心回顾性分析  

Analysing pathogenic bacterial spectrum and drug resistance of bloodstream infection in patients with allogeneic hematopoietic stem cell transplantation

作　　者：丁丽敏 宋晓露[2] 王晓刚[2] 彭也[2] 陈一瑞[2,3] 金莱 蓝建平[2,3] Ding Limin;Song Xiaolu;Wang Xiaogang;Peng Ye;Chen Yirui;Jin Lai;Lan Jianping(Graduate School of Clinical Medicine,Bengbu Medical College,Bengbu 233030,China;Department of Hematology and Hematopoietic Stem Cell Transplant Center,Zhejiang Provincial People's Hospital,People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China;Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province,Hangzhou 310014,China)

机构地区：[1]蚌埠医学院临床医学系研究生院,蚌埠233030 [2]浙江省人民医院血液病科和造血干细胞移植中心,杭州医学院附属人民医院,310014 [3]浙江省肿瘤分子诊断与个体化治疗研究重点实验室,杭州310014

出　　处：《中华血液学杂志》2021年第10期807-813,共7页Chinese Journal of Hematology

基　　金：浙江省自然科学基金(LY17H080008、LY20H080009);浙江省医药卫生科技项目(2018KY241、2020KY015)。

摘　　要：目的了解浙江省人民医院异基因造血干细胞移植(allo-HSCT)患者血流感染临床特点、病原菌谱、耐药性及危险因素。方法回顾性分析2014年10月至2019年9月浙江省人民医院血液科210例allo-HSCT患者中发生血流感染的病原学分布、耐药性、感染危险因素及转归。结果210例allo-HSCT患者中49例发生血流感染,共分离出病原菌59株,以革兰阴性菌为主(67.8%),其中以大肠埃希菌最为常见(23.7%),碳青霉烯类耐药革兰阴性菌(CRO)占42.5%;革兰阳性菌占23.7%,未发现万古霉素及利奈唑胺耐药的葡萄球菌株;真菌占8.5%。单因素分析提示血流感染影响因素有性别、移植前疾病状态、预处理方案;多因素分析显示血流感染主要与预处理方案强度有关(OR=3.043,95%CI 1.236~7.492,P=0.015)。49例血流感染患者中粒细胞缺乏(粒缺)血流感染占77.6%,非粒缺占22.4%;移植前活动性感染患者发生血流感染占81.0%,移植前无活动性感染患者占16.9%。生存分析结果显示,血流感染患者总生存(OS)时间短于未发生血流感染患者,CRO感染患者比无CRO感染患者OS时间短,粒缺时间>14 d患者OS时间较粒缺时间≤14 d患者短,移植前是否合并活动性感染及感染时是否处于粒缺状态与OS时间无明显相关性。结论本研究提示积极预防耐药菌血流感染、缩短粒缺时间、移植前控制感染、适合的预处理方案,能降低移植死亡率、改善预后。Objective To elucidate the clinical characteristics of bloodstream infection in patients with allogeneic hematopoietic stem cell transplantation(allo-HSCT)in our hospital and improves the survival of transplant patients with bloodstream infection.Methods Two hundred and ten patients with allo-HSCT from the Department of Hematology were retrospectively analyzed between October 2014 and September 2019.Pathogen distribution,drug resistance,risk factors,and outcomes were investigated in 49 allo-HSCT patients with bloodstream infections.Results Forty-nine of 210 patients with allo-HSCT had bloodstream infection,and 59 pathogenic microorganisms were identified,mainly Gram-negative bacteria(67.8%),of which E.coli had the highest incidence(23.7%),CRO accounted for 42.5%,and Grampositive bacteria accounted for 23.7%(without vancomycin or linezolid-resistant strain).Additionally,fungi accounted for 8.5%.Univariate analysis suggested that the risk factors of bloodstream infection were gender,pretransplant disease status,and conditioning regimen.In contrast,multivariate analysis showed that bloodstream infection was mainly related to conditioning regimens.Further grouping results showed that 77.6%of patients with neutropenia had bloodstream infections,and 22.4%of patients with nonneutropenia had bloodstream infections;81.0%of patients with active infections before transplantation had bloodstream infections,while bloodstream infection occurred in 16.9%of patients without active infection.Survival analysis showed that long-term survival of patients with bloodstream infection is shorter than that of patients without bloodstream infection and long-term survival of patients with CRO infection is shorter than that of patients without CRO infection.The survival of patients with neutropenia longer than 14 d is shorter than that of patients with neutropenia shorter than 14 d.Furthermore,there is no correlation between whether there is an active infection before transplantation and whether they are in a neutropenic state at the time o

关 键 词：异基因造血干细胞移植 血流感染 病原菌 耐药性 生存期 

分 类 号：R457.7[医药卫生—治疗学]