摘要
目的评价血液肿瘤化疗后中性粒细胞缺乏(粒缺)伴发热患者两种一线经验性抗感染治疗策略的优劣。方法回顾性分析2017年8月—2018年12月某院血液肿瘤化疗后粒缺伴发热病例的感染部位及病原菌分布情况,按一线抗感染治疗方案分为以碳青霉烯类药物为主治疗组(碳青霉烯类组)和以含酶β-内酰胺类抗生素为主治疗组(含酶β-内酰胺类组),对两组病例治疗疗效、住院总费用以及住院日数进行比较。结果共收集粒缺伴发热的病例103例,其中碳青霉烯类组为71例,含酶β-内酰胺类组32例。最常见的感染部位是呼吸道,其次为血液、胃肠道。检出病原菌47株,革兰阴性菌、革兰阳性菌、真菌分别占68.1%、12.8%、19.1%,以肺炎克雷伯菌占比最高为(25.5%),其次为大肠埃希菌(21.3%)和铜绿假单胞菌(8.5%)。碳青霉烯类组、含酶β-内酰胺类组患者治疗有效率分别为90.1%、71.9%,住院总费用分别为(59529.7±39771.3)、(49546.9±31641.1)元,住院日数分别为(28.7±7.9)、(26.2±6.3)d,两组治疗有效率比较,差异有统计学意义(P=0.038),两组患者住院总费用、住院日数比较,差异均无统计学意义(均P>0.05)。结论对血液肿瘤化疗后粒缺伴发热的患者,一线经验性应用碳青霉烯类为主的药物抗感染治疗的疗效优于应用含酶β-内酰胺类为主的药物,两组住院总费用以及住院日数差异不明显。
Objective To evaluate the advantages and disadvantages of first-line empirical anti-infective therapy for patients with chemotherapy-induced febrile neutropenia of hematological malignancy.Methods Infection sites and distribution of pathogens of patients with chemotherapy-induced febrile neutropenia of hematological malignancy in a hospital from August 2017 to December 2018 were retrospectively analyzed,according to first-line anti-infective therapy scheme,patients were divided into carbapenem-based agents group(carbapenem group)andβ-lactamase inhibitor compounds-based agents group(β-lactamase group),therapeutic efficacy,total hospitalization cost and length of hospital stay between two groups were compared.Results A total of 103 cases with chemotherapy-induced febrile neutropenia of hematological malignancy were collected,including 71 cases in carbapenem group and 32 cases inβ-lactamase group.The most common infection site was respiratory tract,followed by bloodstream and gastrointestinal tract.47 strains of pathogens were isolated,Gram-negative bacteria,Gram-positive bacteria and fungi accounted for 68.1%,12.8%and 19.1%respectively,Klebsiella pneumoniae accounted for the highest proportion(25.5%),followed by Escherichia coli(21.3%)and Pseudomonas aeruginosa(8.5%).The effective therapeutic rates of carbapenem group andβ-lactamase group were 90.1%and 71.9%respectively,the total hospitalization cost were(59529.7±39771.3)Yuan and(49546.9±31641.1)Yuan respectively,length of hospital stay were(28.7±7.9)and(26.2±6.3)days respectively,differences in therapeutic rate between two group of patients was statistically significant(P=0.038),differences in total hospitalization cost and length of hospital stay between two group of patients were not statistically significant(both P>0.05).Conclusion For patients with chemotherapy-induced febrile neutropenia of hematological malignancy,first-line empirical application of carbapenems as the main anti-infective therapy is better thanβ-lactamase agents,the total hospitalization cost and length of hospital stay of two groups have no significant difference.
作者
胡丽娜
谢勉
李国强
冯春
柯鹏
张新友
周继豪
HU Li-na;XIE Mian;LI Guo-qiang;FENG Chun;KE Peng;ZHANG Xin-you;ZHOU Ji-hao(Department of Hematology,Shen-zhen People’s Hospital,The Second Clinical Medical College of Jinan University,Shenzhen 518000,China;Department of General Practice Medicine,Shen-zhen People’s Hospital,The Second Clinical Medical College of Jinan University,Shenzhen 518000,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2020年第8期715-720,共6页
Chinese Journal of Infection Control
基金
深圳市人民医院三名工程临床研究培育项目(SYLY201722)。
关键词
中性粒细胞缺乏伴发热
感染部位
病原菌
治疗
住院总费用
住院日数
febrile neutropenia
infection site
pathogen
therapy
total hospitalization cost
length of hospital stay
