摘要
目的分析急性白血病(AL)患儿院内感染的临床特点及血培养阳性细菌对抗生素的敏感性,探讨其防治措施。方法回顾性分析住院AL患儿院内感染的发生率;细菌感染血培养阳性与化疗时期的关系,血培养阳性患儿与阴性患儿外周血白细胞计数、血小板计数、粒细胞计数绝对值的差异,血培养阳性细菌对抗生素的耐药性及敏感性。结果 AL患儿院内感染的发生率为45.5%(112/246),其中血培养阳性率为25.0%(28/112)。血培养阳性患儿的外周血白细胞计数为(1.05±1.17)×109/L,血小板计数为(55.57±27.57)×109/L,中性粒细胞计数绝对值为(0.13±0.33)×109/L,中性粒细胞减少持续时间为(8.46±3.40)d;血培养阴性患儿的白细胞计数为(2.72±3.00)×109/L,血小板计数为(117.80±133.60)×109/L,中性粒细胞计数绝对值为(1.02±2.34)×109/L,中性粒细胞减少持续时间为(2.48±0.62)d,各项指标在血培养阳性组与阴性组之间的差异有显著性。血培养中的葡萄球菌属、大肠埃希菌、铜绿假单胞菌对青霉素类、头孢三代抗生素、红霉素的耐药率均比较高,葡萄球菌属对替考拉宁和万古霉素相对较敏感,大肠埃希菌对亚胺培南敏感性较高,铜绿假单胞菌对亚胺培南和复方新诺明较敏感。结论本研究结果提示,AL患儿骨髓抑制易发生感染。AL患儿考虑革兰阴性菌感染可选择碳青霉烯类,考虑革兰阳性菌感染可选择替考拉宁和万古霉素,必要时进行细菌药敏物敏感试验,进一步提高治疗效果。
Objective To analyze the clinical characteristics of hospital infection in children with acute leukemia （AL） , including bacterial sensitivity to antibiotics and the strategy of prevention and treatment. Methods The incidence rate of hospital infection in children with AL were analyzed retrospectively. The relationship between positive rate of hemocuhure and chemotherathy period were investigated. White blood cell （WBC） counts, platelet （PLT） counts, neutrophil counts and hemocuhure results were analyzed. Results The incidence rate of hospital infection was 45.5% （ 112/246 ）. The positive rate of hemoculture was 25.0% （28/112）. WBC counts, PLT counts, neutrophil counts and neutropenia duration were （ 1.05 ± 1.17 ）× 10^9/L, （55.57±27.57 ） × 10^9/L, （0.13 ± 0.33 ） × 10^9/L, （ 8.46 ± 3.40） days in positive group and （ 2.72 ± 3.00） × 10^9/L, （ 117.8±1 33. 6） × 10^9/L, （ 1.02 ±2. 34） × 10^9/L, （2.48 ± 0.62）days in negative group, respectively. The differences between two groups were significant. Staphylococcus, Escherichia coli and Pseudomonas aeruginosa showed higher resistance to penicillins, third generation cephalosporin antibiotics and erythromycin. Staphylococcus showed sensitivity＂ to teicoplanin and vancomycin; Escherichia coil were more sensitive to imipenem; Pseudomonas aeruginosa were sensitive to imipenem and cotrimoxazole. Conclusions Children with AL are often complicated with myelosuppression during chemotherapy, and easy to get bacterial infections. AL children with G- bacterial infections could be treated with carbapenems, while those with G^＋ bacterial infections could be treated with teicoplanin or vancomycin. It is necessary to detect bacterial sensitivity to antibiotics in order to improve the therapeutic effect.
出处
《中国小儿血液与肿瘤杂志》
CAS
2012年第1期22-25,共4页
Journal of China Pediatric Blood and Cancer
关键词
儿童
急性白血病
院内感染
血培养
Children
Acute leukemia
Hospital infection
Blood culture
