摘要
目的探讨儿童恶性血液病化疗后合并嗜麦芽窄食单胞菌血流感染的临床特征及预后。方法回顾性分析2013年1月至2018年5月福建医科大学附属协和医院25例恶性血液病化疗后合并嗜麦芽窄食单胞菌血流感染患儿的临床资料及药敏试验结果。结果25例患儿中,男性18例,女性7例;中位年龄4岁(1~11岁),均明确诊断恶性血液病并接受化疗。感染前使用碳青霉烯类抗生素超过1周[80%(20/25)]、中性粒细胞缺乏超过1周[68%(17/25)]及留置中心静脉导管[48%(12/25)]为常见易感因素。临床上主要表现为化疗后中性粒细胞缺乏伴发热,且予抗单胞菌头孢菌素或碳青霉烯类抗生素联合万古霉素抗感染以及抗真菌均治疗无效。药敏试验显示,所有菌株均对复方磺胺甲唑、左氧氟沙星、米诺环素敏感。血培养报告前有3例患儿因感染性休克、肺出血呼吸衰竭死亡;血培养报告后,治疗调整为复方磺胺甲唑联合头孢哌酮钠舒巴坦钠(每天200~260 mg/kg)或左氧氟沙星抗感染,18例治愈,2例因基础病疗效不佳死亡,2例因肺出血死亡。总病死率为28%(7/25),因嗜麦芽窄食单胞菌血流感染相关死亡率为20%(5/25)。结论儿童恶性血液病化疗后合并嗜麦芽窄食单胞菌血流感染病死率高,而较好的基础疾病控制以及恰当的抗菌治疗是改善预后的关键。
ObjectiveTo investigate the clinical features and prognosis of children with hematological malignancies after chemotherapy accompanied with Stenotrophomonas maltophilia blood stream infection(BSI).MethodsThe clinical data and antimicrobial susceptibility test of 25 hospitalized children with hematological malignancies who were diagnosed as Stenotrophomonas maltophilia BSI in the Department Pediatric Hematology of Fujian Medical University Union Hospital from January 2013 to May 2018 were analyzed retrospectively.ResultsA total of 25 children,including 18 males and 7 females with the median age 4(1-11)years old were diagnosed as hematological malignancies and all received chemotherapy.The frequent risk factors of Stenotrophomonas maltophilia BSI in children with hematological malignancies included prior carbapenem antibiotic for more than 1 week(80%,20/25),and neutropenia for more than 1 week(68%,17/25)and indwelling central venous catheter(48%,12/25).Clinically,the main manifestations included neutropenia with fever after chemotherapy;however,anti-pseudomonas cephalosporin/carbicillin antibiotic combined with vancomycin and anti-fungal therapies were ineffective.Drug susceptibility test showed that all strains were sensitive to compound sulfamethoxazole,levofloxacin and minocycline.Before blood culture report,3 patients died of septic shock,pulmonary hemorrhage and respiratory failure;after blood culture report,the treatment regimens were adjusted to compound sulfamethoxazole combined with cefoperazone sodium and sulbactam sodium(200-260 mg·kg^-1·d^-1)or levofloxacin anti-infective.Finally,18 patient was cured,2 patients died of the bad efficacy of underlying diseases,and 2 patients died of pulmonary hemorrhage.The overall fatality rate was 28%(7/25)and the related mortality rate caused by Stenotrophomonas maltophilia BSI was 20%(5/25).ConclusionStenotrophomonas maltophilia BSI in children with hematological malignancies after chemotherapy has a high fatality rate,and better basic disease control and appropriate antibacterial therapy are the key to improve the prognosis.
作者
郑湧智
李健
胡建达
Zheng Yongzhi;Li Jian;Hu Jianda(Department of Pediatric Hematology,Fujian Institute of Hematology,Fujian Provincial Key Laboratory,Fujian Medical University Union Hospital,Fuzhou 350001,China)
出处
《白血病．淋巴瘤》
CAS
2019年第1期34-38,共5页
Journal of Leukemia & Lymphoma
基金
福建省血液医学中心建设项目[闽政办(2017)4号]
福建医科大学苗圃科研基金(2015MP022).
关键词
血液肿瘤
血液病
嗜麦芽窄食单胞菌
血流感染
儿童
预后
Hematologic neoplasms
Hematologic diseases
Stenotrophomonas maltophilia
Blood stream infection
Child
Prognosis
