儿童急性白血病合并多重耐药菌血流感染的临床特征及抗菌药物选择  

The Clinical Features and Antibiotic Selection in Children with Acute Leukemia Complicated by Bloodstream Infections from Multidrug-Resistant Bacteria

作　　者：孙建明[1] 李源[1] 苏琴[1] SUN Jianming;LI Yuan;SU Qin(Dept.of Pharmacy of Kunming Children’s Hospital,Kunming Yunnan 650228,China)

机构地区：[1]昆明市儿童医院药剂科,云南昆明650228

出　　处：《昆明医科大学学报》2024年第11期137-143,共7页Journal of Kunming Medical University

基　　金：昆明市卫生健康委员会卫生科研基金资助项目(2022-13-01-002)。

摘　　要：目的探讨急性白血病患儿合并多重耐药菌(multiple resistant bacteria,MDR)血流感染的临床特征、独立危险因素及抗菌药物选择。方法回顾性分析2015年1月至2023年12月昆明市儿童医院收治的101例合并细菌血流感染的急性白血病患儿。根据血培养结果,将符合MDR、泛耐药及全耐药标准的患儿纳入多重耐药组(n=47例),其余纳入非多重耐药组(n=54例),记录2组临床特征、实验室指标及抗菌药物选择情况,并分析影响MDR感染的危险因素。结果MDR组急性髓系白血病(acute myeloid leukemia,AML)比例、诱导缓解化疗前粒细胞缺乏时间≥7 d的比例均高于非MDR组,MDR组发热前血红蛋白(hemoglobin,Hb)和血小板(platelet,PLT)水平均低于非MDR组,差异有统计学意义(P<0.05);急性髓系白血病、诱导缓解化疗、发热前粒细胞缺乏时间≥7 d,感染前Hb<79 g/L及感染前PLT<20×109/L均为MDR感染的独立危险因素(P<0.05);病原学分析表明,革兰阴性菌为主要致病菌,耐药率高,但对碳青霉烯类、替加环素敏感;革兰阳性菌对特定抗菌药敏感,而对红霉素高度耐药;MDR组降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)水平均高于非MDR组,且MDR组转入ICU的比例较高,差异有统计学意义(P<0.05)。结论急性髓系白血病、诱导缓解化疗、发热前粒细胞缺乏时间≥7 d、血红蛋白<70 g/L、PLT<20×109/L均为儿童MDR血流感染的独立危险因素,影响预后,大肠埃希菌为主要耐药菌,MDR感染患儿表现PCT和CRP水平升高,痊愈率低;因此,针对高危因素需采取有效预防措施,并根据药敏结果及时调整治疗方案,提高疗效。Objective To investigate the clinical features,independent risk factors,and antibiotic selection in children with acute leukemia complicated by multidrug-resistant(multiple resistant bacteria,MDR)bloodstream infections.Methods A retrospective analysis was conducted on 101 children with acute leukemia complicated by bacterial bloodstream infections and treated at Kunming Children's Hospital from January 2015 to December 2023.Based on blood culture results,patients meeting the criteria for multidrug-resistant(MDR),extensively drug-resistant(XDR),and pandrug-resistant(PDR)were included in the multidrug-resistant group(n=47),while the remaining patients were included in the non-multidrug-resistant group(n=54).Clinical features,laboratory indicators,and antibiotic selection were recorded for both groups,and the risk factors influencing MDR infections were analyzed.Results The proportion of acute myeloid leukemia(AML)and the percentage of patients with neutropenia lasting≥7 days before the induction chemotherapy were both higher in the MDR group compared to the non-MDR group.Additionally,the levels of hemoglobin(Hb)and platelets(PLT)before fever in the MDR group were lower than those in the non-MDR group,and there was statistically significant difference(P<0.05).The results indicated that acute myeloid leukemia,neutropenia lasting≥7 days before induction chemotherapy,Hb<79 g/L before and after the infection,and PLT<20×109/L before the infection were independent risk factors for MDR infections(P<0.05).Microbiological analysis showed that Gram-negative bacteria were the primary pathogens,with a high resistance rate but sensitivity to carbapenems.Gram-positive bacteria were sensitive to specific antibiotics but showed high resistance to erythromycin.Furthermore,the levels of procalcitonin(PCT)and C-reactive protein(CRP)in the MDR group were higher than those in the non-MDR group,and the proportion of patients transferred to the ICU was significantly higher in the MDR group(P<0.05).Conclusion Ac-ute myeloid leukemia,n

关 键 词：儿童急性白血病 血流感染 化疗 多重耐药 抗菌药物选择 

分 类 号：R733.71[医药卫生—肿瘤]