摘要
目的:分析血液病患者造血干细胞移植(HSCT)术后100 d内感染的临床特征。方法:收集2013年1月至2019年1月期间本院血液科313例HSCT患者感染时送检培养结果,分析其感染的发生率、病原菌分布、药敏实验结果及感染危险因素。结果:313例HSCT患者中,262(83.7%)例患者在100 d内出现感染,其中234例(89.3%)患者感染时处在中性粒细胞缺乏期。共分离病原菌156株,其中血流感染位列第一,占64.1%。分离菌株中,革兰阴性(G^-)菌86株(55.1%),高于革兰阳性(G^+)菌(31.4%,49株),真菌占13.5%(21株)。产超广谱β内酰胺酶(ESBLs)在大肠埃希菌及肺炎克雷伯杆菌中的检出率分别为36.4%和31.6%,大肠埃希菌、肺炎克雷伯菌对碳青霉烯类药物耐药率分别为18.20%和5.3%,对阿米卡星耐药率分别约为29.5%和10.5%。发酵菌对抗菌药物耐药情况差异较大,铜绿假单胞菌及鲍曼不动杆菌对碳青霉烯类药物耐药率较高。仅发现1株耐甲氧西林金黄色葡萄球菌(MRSA)。G^+菌中仅粪肠球菌对利奈唑胺存在耐药率为14.30%,其余G^+菌对万古霉素、替考拉宁、利奈唑胺敏感率均为100%。真菌中以曲霉菌(10.3%)为主。本院HSCT以异基因为主,单因素分析显示,感染的危险因素为移植前疾病状态、HLA配型、首次移植住院时间、粒缺时间;多因素分析显示,只有HLA配型有统计学意义。结论:本院患者HSCT术后感染多发生在移植后粒缺期,致病菌以G^-菌为主,耐药情况较严峻,且HLA配型不合是allo-HSCT术后感染发生的独立危险因素,积极监测本院病原菌分布、耐药情况及感染危险因素,有利于更加合理、规范的指导临床治疗。
Objective:To analyze the clinical characteristics of infection within 100 days after hematopoietic stem cell transplantation(HSCT)in patients with hematologic disease.Methods:The culture results of 313 HSCT patients infected in the hematology department of our hospital from January 2013 to January 2019 were collected,and the infection incidence,pathogen distribution,drug susceptibility test results and infection risk factors out of them all were analyzed.Results:Among 313 HSCT patients,infection occurred within 100 days in 262(83.7%)patients,234(89.3%)cases were in neutropenic period at infection onset.156 pathogen distributions showed that the bloodstream infection(64.1%)ranked first.Among isolates,Gram-negative bacteria was 86(55.1%),which were higher than Gram-positive bacteria(49,31.4%),and fungi was 21(13.5%).The prevalence of ESBLs in E.coli and Klebsiella pneumoniae were 36.4%and 31.6%,respectively.The drug resistance rates of E.coli and Klebsiella pneumoniae to carbapenems were 18.20%and 5.3%,respectively,and to amikacin were 29.5%and 10.5%,respectively.The antimicrobial resistance of fermentation bacteria was significantly different.The drug resistence rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems were high.Only one strain of methicillin-resistant staphylococcus aureus(MRSA)was found.The drug resistence rates of enterococcus faecalis to linezolid was 14.30%.The sensitivity of other Gram-positive bacteria to vancomycin,teicolanin and linezolid was 100%.The HSCT in our hospital was mainly allogeneic,and univariate analysis showed that the risk factors for infection were status before trasplantion,HLA matching type,length of stay for the first transplant,and length of neutropenia,while Mulvariate analysis showed that only HLA matching type showed statistical significance.Conclusion:The infection of patients after HSCT occurrs in period of neutropenia,Most of pathogens are G-bacteria,and the resistance to antibiotics is quite common,HLA mismatch is allo-HSCT independent risk factors for infection.It is very imprtant to monitor actively the distribution of pathogenic bacteria,drug-resistance and risk factors of infection for guiding more reasonable and standardized clinical treatment.
作者
冯丹
张永甜
邱婷婷
徐开林
FENG Dan;ZHANG Yong-Tian;QIU Ting-Ting;XU Kai-Lin(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2020年第2期602-608,共7页
Journal of Experimental Hematology
基金
国家自然科学基金(81400129),中国博士后科学基金(2015113010)。
关键词
造血干细胞移植
病原菌
感染
耐药性
hematopoietic stem cell transplantation
pathogenic bacteria
infection
drug resistance
