急性髓系白血病诱导化疗后粒细胞缺乏伴发热感染患者的临床表现和病原菌分布及其耐药性分析  

Analysis of clinical manifestations,distribution of pathogens and drug resistance in patients with acute myelogenous leukemia and fever infection after induction chemotherapy

作　　者：李清叶[1] 聂泽强 LI Qingye;NIE Zeqiang(Hunan Polytechnic of Environment and Biology,Hengyang,Hu'nan,421000,China;Department of Hematology,Yuncheng Central Hospital,Yuncheng,Shanxi,044000,China)

机构地区：[1]湖南环境生物职业技术学院医学院,湖南衡阳421000 [2]运城市中心医院血液科,山西运城044000

出　　处：《当代医学》2023年第4期11-15,共5页Contemporary Medicine

摘　　要：目的分析急性髓系白血病(AML)诱导化疗后粒细胞缺乏伴发热感染患者的临床表现、病原菌分布及其耐药性分析。方法回顾性分析2017年7月至2020年7月运城市中心医院收治的32例AML诱导化疗后出现粒细胞缺乏伴发热感染患者的临床资料,分析患者临床表现、病原菌感染部位分布、病原菌类型、不同病原菌的耐药性。结果32例AML粒细胞缺乏伴发热感染患者中,伴发咳嗽21例,占比为65.63%;恶心呕吐22例,占比为68.75%;腹泻14例,占比为43.75%;寒战18例,占比为56.25%;水肿12例,占比为37.50%;黏膜破溃9例,占比为28.13%。感染部位明确22例,占比为68.75%,以呼吸道、血液占比较高,分别为45.45%、22.73%。病原菌类型:32例AML粒细胞缺乏伴发热感染患者中,共检出病原菌36株,其中细菌34株,占比为94.44%,以革兰氏阴性菌为主,占比为66.67%,革兰氏阳性菌次之,占比为27.78%;真菌感染2株,占比为5.56%,均为假丝酵母菌。革兰氏阴性菌中,大肠埃希菌对头孢呋辛、头孢曲松、头孢噻肟和左氧氟沙星及磺胺甲恶唑有一定耐药性,对亚胺培南、厄他培南及替加环素完全敏感,敏感率均为100.00%;肺炎克雷伯杆菌对头孢噻肟高度耐药,耐药率为75.00%,对头孢呋辛、磺胺类磺胺甲恶唑高度敏感,敏感率均为75.00%,对亚胺培南、厄他培南及替加环素完全敏感,敏感率均为100%.00;革兰氏阳性菌中,CNS对青霉素、磺胺甲恶唑高度耐药,耐药率分别为100.00%、80.00%,对万古霉素及左氧氟沙星、利福平高度敏感,敏感率分别为100.00%、80.00%、80.00%;金黄色葡萄球菌对青霉素完全耐药,耐药率为100.00%,对万古霉素、四环素、左氧氟沙星、磺胺甲恶唑、利福平完全敏感,敏感率均为100.00%;假丝酵母菌对两性霉素B完全敏感,敏感率为100.00%,对氟康唑、伏立康唑有一定耐药性,耐药性均为50.00%。结论AML诱导化疗后粒细胞缺乏伴发热感染患者以呼吸道感Objective To analyze the clinical manifestations,distribution of pathogens and drug resistance of patients with acute myelogenous leukemia(AML)and fever infection after induction chemotherapy.Methods The clinical data of 32 patients with agranulocytosis and fever infec-tion after AML induction chemotherapy admitted to Yuncheng Central Hospital from July 2017 to July 2020 were analyzed retrospectively,the clini-cal manifestations,distribution of pathogenic bacteria infection sites,types of pathogenic bacteria,and drug resistance of different pathogenic bacte-ria were analyzed.Results Among the 32 cases of AML patients with fever infection,21 cases had cough,accounting for 65.63%;22 cases of nau-sea and vomiting,accounting for 68.75%;14 cases of diarrhea,accounting for 43.75%;18 cases of shivering,accounting for 56.25%;12 cases of ede-ma,accounting for 37.50%;9 cases of mucosal ulceration,accounting for 28.13%.The infection site were confirmed in 22 cases,accounting for 68.75%,with the highest proportion of the respiratory tract and blood 45.45%and 22.73%,respectively.Type of pathogenic bacteria:among 32 pa-tients with AML with fever infection,36 strains of pathogenic bacteria were detected,among which 34 strains were bacteria,accounting for 94.44%,the main strains were Gram-negative bacteria,accounting for 66.67%,followed by Gram-positive bacteria,accounting for 27.78%;two strains of fun-gal infection,accounting for 5.56%,all of which were Candida.Among Gram-negative bacteria,Escherichia coli had certain resistance to cefurox-ime,ceftriaxone,cefotaxime,levofloxacin and sulfamethoxazole,and was completely sensitive to imipenem,ertapenem and tigacycline,with sensi-tivity rates of 100.00%;Klebsiella pneumoniae was highly resistant to cefotaxime with a resistance rate of 75.00%,highly sensitive to cefuroxime and sulfamethoxazole with a sensitivity rate of 75.00%,and completely sensitive to imipenem,ertapenem and tigecycline with a sensitivity rate of 100.00%;among Gram-positive bacteria,CNS was highly resistant to pen

关 键 词：急性髓系白血病 诱导化疗 感染 药敏试验 

分 类 号：R733.71[医药卫生—肿瘤]