血液系统恶性肿瘤与实体肿瘤患者碳青霉烯耐药肠杆菌科细菌定植分布特点及主动筛查评价  

Active screening for distribution of carbapenem-resistant Eenterobacteriaceae in patients with hematological malignancies or solid tumors

作　　者：李宁[1] 陈小会[1] 周晖[1] 辛晓阳 唐婷婷[1] 唐慧芬 安娜[1] 陈航 LI Ning;CHEN Xiaohui;ZHOU Hui;XIN Xiaoyang;TANG Tingting;TANG Huifen;AN Na;CHEN Hang(Department of Hematology and Oncology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院肿瘤血液科,310015

出　　处：《浙江医学》2022年第7期729-732,共4页Zhejiang Medical Journal

基　　金：浙江省医学会临床科研基金项目(2018ZYC-A34)。

摘　　要：目的观察血液系统恶性肿瘤与实体肿瘤患者碳青霉烯耐药肠杆菌科细菌(CRE)定植分布情况,并评价主动筛查对于患者CRE定植和血流感染的影响。方法选取2018年1月至2020年12月杭州师范大学附属医院肿瘤血液科收治的接受化疗的恶性肿瘤患者262例,其中血液系统恶性肿瘤200例,实体肿瘤62例。2018年1至6月收治的26例患者为单次筛查组,仅在患者化疗前进行单次肠道CRE筛查,阳性患者每周复查,阴性患者未再进行筛查;2018年7月至2020年12月收治的236例患者为主动筛查组,患者进行至少3个时间点(化疗前、化疗后中性粒细胞缺乏期、中性粒细胞缺乏伴发热期)的肠道CRE筛查,对出现发热或腹痛、腹泻、肛周炎症等肠道并发症的患者进行重复肠道CRE筛查。观察患者CRE定植分布,并比较两组患者CRE筛查阳性率。结果262例患者中CRE筛查阳性的菌种以肺炎克雷伯菌和大肠埃希菌检出率最高,分别为69.50%和22.03%。CRE筛查阳性的病种统计,血液系统恶性肿瘤(22.00%)高于实体肿瘤(17.74%),尤其以急性白血病筛查阳性率最高(27.63%),且血液系统肿瘤CRE血流感染率(2.01%)也明显高于实体肿瘤(0.00%)。主动筛查组患者CRE筛查阳性率高于单次筛查组(17.82%比4.76%,P<0.05)。结论血液系统恶性肿瘤患者肠道CRE定植率、血流感染率均高于实体肿瘤,主动肠道CRE筛查有助于提高筛查阳性率,早期进行干预治疗,改善患者预后。Objective To evaluate the effectiveness of screening for distribution of carbapenem-resistant Enterobacteriaceae(CRE)in patients with hematological tumors and solid tumors.Methods A total of 262 patients receiving chemotherapy in Department of Oncology and Hematology,the Affiliated Hospital of Hangzhou Normal University from January 2018 to December 2020 were enrolled,including 200 patients with hematological malignancy and 62 patients with solid tumor.Patients admitted from January to June 2018 underwent a single intestinal CRE screening before chemotherapy(n=26,single screening group),if it was positive,patients were reviewed weekly.The remaining 236 patients underwent from July 2018 to December 2020 at least three intestinal CRE screenings:before chemotherapy,leukocytonenia and leukocytopecia with fever after chemotherapy(active screening group),if patients had fever or abdominal pain,diarrhea,inflammatory bowel complications repeated bowel CRE screening was given.The distribution of CRE colonization was observed and the positive rate of CRE screening and the infection rate were compared between the two groups.Results Among 262 patients,the detection rate of carbapenem-resistant Klebsiella pneumoniae was the highest(69.50%),followed by that of Escherichia coli(22.03%).The positive screening rate in patients with hematological tumors was higher than that with solid tumors(22.00%vs.17.74%),particularly in patients with acute leukemia(27.63%).The CRE bloodstream infection rate(2.01%)in patients with hematological tumors was significantly higher than that in patients with solid tumors(0.00%).The positive rate of intestinal CRE in active screening group was significantly higher than that of single screening group(17.82%vs.4.76%,P<0.05).Conclusion Intestinal CRE colonization rate,bloodstream infection rate and mortality rate of hematological malignancies are higher than those of solid tumors.Ac-tive intestinal CRE screening can increase the active screening rate for early intervention and treatment to improve the pr

关 键 词：血液系统恶性肿瘤 实体肿瘤 碳青霉烯耐药肠杆菌科细菌 主动筛查 

分 类 号：R730.4[医药卫生—肿瘤]