恶性血液病合并血流感染病原菌分布及发生脓毒症休克危险因素分析  

Analysis of the distribution of pathogenic bacteria and risk factors for sepsis shock in hematologic malignancies with bloodstream infection

作　　者：高陆 彭志元 任娜娜 杨春秀 赵凌苇 任明强 冯永怀 Gao Lu;Peng Zhiyuan;Ren Nana;Yang Chunxiu;Zhao Lingwei;Ren Mingqiang;Feng Yonghuai(Department of Hematology,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563003,China)

机构地区：[1]遵义医科大学附属医院血液内科,贵州遵义563003

出　　处：《遵义医科大学学报》2024年第3期254-261,共8页Journal of Zunyi Medical University

基　　金：遵义市联合基金资助项目[NO:遵市科合HZ字(2021)93];遵义市联合基金资助项目[NO:遵市科合HZ字(2023)299]。

摘　　要：目的 分析我院恶性血液病患者血流感染(BSI)病原菌分布及发生脓毒症休克的危险因素。方法 收集纳入研究的2016年1月至2023年8月在遵义医科大学附属医院血液内科治疗的223例恶性血病患者BSI病例资料,根据血流感染后是否并发脓毒症休克,分为脓毒症休克和非脓毒症休克组。收集病例的原发病类型,临床表现,病原菌及药敏结果、中性粒细胞缺乏持续时间、是否合理使用抗生素、是否为多重耐药、是否有使用广谱抗生素史等相关指标进行相关因素分析。采用Logistic回归对恶性血液病患者BSI并发脓毒症休克相关因素进行单因素和多因素分析。结果 223例血流感染患者血培养出238株病原菌,革兰阴性菌142株(59.70%),其中肺炎克雷伯菌25株、大肠埃希菌75株;革兰阳性菌93株(39%),其中人葡萄球菌28株、表皮葡萄球菌22株、金黄色葡萄球菌9株;真菌3株(1.30%),其中热带念珠菌、近平滑假丝酵母菌、克柔假丝酵母菌各1株。223例血液病合并血流感染病例中,发生脓毒症休克25例,死亡16例(64%)。单因素分析结果显示,脓毒症休克和非脓毒症休克组在粒细胞缺乏期(P<0.001)、合理使用抗生素(P=0.007)、多重耐药(P=0.017)、合并心功能不全(P=0.018)、肾功能不全(P<0.001)中存在差异。多因素分析结果显示粒细胞缺乏时间≥7 d(OR=3.306,P=0.008)、不合理使用抗生素(OR=2.612,P=0.004)、心功能不全(OR=6.291,P=0.008)、急性肾功能不全(OR=8.419,P=0.002)是恶性血液病BSI发生感染性休克的独立危险因素。结论 恶性血液病合并BSI病原菌以革兰氏阴性菌为主,降低恶性血液病血流感染患者发生脓毒症休克的措施,包括缩短粒缺期、尽早合理使用抗菌药、纠正心脏及肾功能不全。Objective To analyze the distribution of pathogenic bacteria in bloodstream infections(BSI)in patients with hematologic malignancies in our hospital and the risk factors for sepsis shock.Methods The case data of 223 patients with malignant hematologic disease treated in the Department of Hematology of the Affiliated Hospital of Zunyi Medical University from 2016 to 2023 were collected.The patients were divided into sepsis shock and non-sepsis shock groups based on sepsis shock occurred after bloodstream infection.The primary disease type,clinical manifestation,pathogenic bacteria and drug sensitivity results,duration of neutropenia,rational use of antibiotics,multi-drug resistance,history of using broad-spectrum antibiotics,and other related indicators were collected for correlation analysis.Logistic regression was used to analyze the related factors of BSI complicated with sepsis shock in patients with malignant hematologic disease.Results 238 strains of pathogenic bacteria were cultured from 223 patients with bloodstream infections.142 strains(59.70%)were Gram-negative bacteria,including 25 strains of Klebsiella pneumoniae and 75 strains of Escherichia coli;93 strains(39%)were Gram-positive bacteria,including 28 strains of Staphylococcus aureus,22 strains of Staphylococcus epidermidis,and 9 strains of Staphylococcus aureus;3 strains(1.30%)were Fungi,including Candida tropicalis,Candida parapsilosis,and Candida krusei.Among the 223 cases of hematologic disease with bloodstream infections,25 cases developed sepsis shock and 16 cases died(64%).Univariate analysis showed that there were differences between the sepsis shock and non-sepsis shock groups in the period of granulocytopenia(P<0.001),reasonable use of antibiotics(P=0.007),multidrug resistance(P=0.017),combined cardiac insufficiency(P=0.018),and renal insufficiency(P<0.001).Multivariate analysis showed that the duration of granulocytopenia≥7 days(OR=3.306,P=0.008),unreasonable use of antibiotics(OR=2.612,P=0.004),cardiac insufficiency(OR=6.291,P=0.008),an

关 键 词：恶性血液病 血流感染 病原菌分布 脓毒症休克 危险因素 

分 类 号：R552[医药卫生—血液循环系统疾病]