血液病患者造血干细胞移植后血流感染及耐碳青霉烯类革兰阴性杆菌定植的重点菌群监测和临床分析  

Key microbial monitoring and clinical analysis of bloodstream infections and CRO colonization after hematopoietic stem cell transplantation in hematological patients

作　　者：张奥 千晨静 韦若文 姜姗 方峻[1] 石威 夏凌辉[1] Zhang Ao;Qian Chenjing;Wei Ruowen;Jiang Shan;Fang Jun;Shi Wei;Xia Linghui(Department of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血液科,武汉430022

出　　处：《中华血液学杂志》2024年第2期134-140,共7页Chinese Journal of Hematology

摘　　要：目的探讨造血干细胞移植(HSCT)后感染和定植的病原菌分布及临床特征,以期为血液病患者移植后并发感染的重点菌群监测与临床诊疗提供初步研究依据。方法回顾性分析2018年1月至2022年12月华中科技大学同济医学院附属协和医院血液科190例微生物检测[革兰阴性菌(G-菌)血培养和/或肛拭子耐碳青霉烯类革兰阴性菌(CRO)筛查]阳性患者的临床资料,根据患者检测结果分为血培阳组、肛拭阳组、双阳组。统计分析比较三组患者情况。结果63例发生G-菌血流感染(BSI)的患者分离病原菌排名前四位的为大肠埃希菌(28株,43.75%)、肺炎克雷伯菌(26株,40.63%)、铜绿假单胞菌(3株,4.69%)和阴沟肠杆菌(3株,4.69%)。147例发生CRO肛周定植的患者分离病原菌排名前三位的为耐碳青霉烯肺炎克雷伯菌(58株,32.58%)、耐碳青霉烯大肠埃希菌(49株,27.53%)、耐碳青霉烯阴沟肠杆菌(20株,11.24%)。双阳组患者的3年无病生存(DFS)率和总生存(OS)率与血培阳组和肛拭阳组相比显著降低(DFS:35.6%对53.7%对68.6%,P=0.001;OS:44.4%对62.4%对76.9%,P<0.001),非复发死亡率(NRM)显著增高(50.0%对34.9%对10.6%,P<0.001)。血小板未植入和发生BSI为NRM的独立危险因素(P<0.001)。加用多黏菌素和(或)头孢他啶阿维巴坦后使用天数>7 d为NRM的独立保护因素(P=0.035)。结论发生BSI会显著增加血液病患者HSCT后的NRM;CRO定植加入血会严重影响其DFS和OS。Objective To investigate the distribution and clinical characteristics of pathogenic bacteria following hematopoietic stem cell transplantation(HSCT),as well as to provide a preliminary research foundation for key microbial monitoring,and clinical diagnosis and treatment of infections after HSCT in hematological patients.Methods We retrospectively analyzed the clinical data of 190 patients who tested positive for microbial testing[G-bacteria blood culture and/or carbapenem-resistant organism(CRO)screening of perianal swabs]at our center from January 2018 to December 2022.Patients were divided into blood culture positive,perianal swab positive,and double positive groups based on the testing results.The three patient groups underwent statistical analysis and comparison.Results The top four pathogenic bacteria isolated from sixty-three patients with G-bacteria bloodstream infection(BSI)were Escherichia coli(28 strains,43.75%),Klebsiella pneumonia(26 strains,40.63%),Pseudomonas aeruginosa(3 strains,4.69%),and Enterobacter cloacae(3 strains,4.69%).The top three pathogenic bacteria isolated from 147 patients with CRO perianal colonization were carbapenem-resistant Klebsiella pneumoniae(58 strains,32.58%),carbapenem-resistant Escherichia coli(49 strains,27.53%),and carbapenem-resistant Enterobacter cloacae(20 strains,11.24%).The 3-year disease-free survival(DFS)and overall survival(OS)of double positive group patients were significantly lower compared to those in the blood culture and perianal swab positive groups(DFS:35.6%vs 53.7%vs 68.6%,P=0.001;OS:44.4%vs 62.4%vs 76.9%,P<0.001),while non-relapse mortality(NRM)was significantly higher(50.0%vs 34.9%vs 10.6%,P<0.001).Failed engraftment of platelets and BSI are independent risk factors for NRM(P<0.001).Using polymyxin and/or ceftazidime-avibactam for more than 7 days is an independent protective factor for NRM(P=0.035).Conclusion This study suggests that the occurrence of BSI significantly increases the NRM after HSCT in patients with hematological diseases;CRO colonizat

关 键 词：造血干细胞移植 血流感染 肛周定植 耐碳青霉烯类革兰阴性杆菌 耐碳青霉烯肠杆菌 

分 类 号：R55[医药卫生—血液循环系统疾病] R457.7[医药卫生—内科学]