摘要
目的探讨该院急性白血病(AL)合并血流感染(BSI)的病原菌分布、耐药现况及预后影响因素。方法选取2018年10月1日至2021年10月26日于该院血液科就诊的AL患者341例为研究对象,其中75例发生BSI。分析AL合并BSI患者的临床及实验室资料;采用基质辅助激光解吸电离飞行时间质谱仪鉴定病原菌;采用VITEK 2 Compact全自动微生物分析仪和K-B法进行药物敏感试验;采用多因素Logistic回归分析影响预后的危险因素。结果该院AL患者BSI发生率为22.0%,病死率为28.0%。革兰阴性菌分离率为71.6%,主要是大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌,除对美罗培南、哌拉西林/他唑巴坦、替加环素、阿米卡星等较敏感外,其他菌株耐药率较高。革兰阳性菌分离率为25.3%,主要是金黄色葡萄球菌、屎肠球菌和链球菌属,除对万古霉素、利奈唑胺、奎奴普丁/达福普汀、替加环素等较敏感外,其他菌株耐药率较高。真菌分离率为3.2%,均为念珠菌,且均对伊曲康唑表现为非敏感。多因素Logistic回归分析结果显示,年龄大、急性淋巴细胞白血病、脓毒血症或感染性休克是影响AL合并BSI患者预后的独立危险因素。结论引起AL患者发生BSI的主要病原菌为革兰阴性菌,抗感染宜选用美罗培南、哌拉西林/他唑巴坦及替加环素;抗革兰阳性菌感染治疗宜选用万古霉素、利奈唑胺及替加环素。
Objective To investigate the distribution,drug resistance and prognostic factors of pathogenic bacteria in acute leukemia(AL)complicated with bloodstream infection(BSI)in this hospital.Methods A total of 341 AL patients who were treated in department of hematology of this hospital from October 1,2018 to October 26,2021 were selected as the research subjects,of which 75 patients developed BSI.The clinical and laboratory data of AL patients with BSI were analyzed;the pathogenic bacteria were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry;VITEK 2 Compact automatic microbiological analyzer and K-B method were used to conduct drug susceptibility test;multivariate Logistic regression was used to analyze the risk factors affecting prognosis.Results The incidence of BSI in AL patients in this hospital was 22.0%,and the mortality rate was 28.0%.The isolation rate of Gram-negative bacilli was 71.6%,mainly Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,except for meropenem,piperacillin/tazobactam,tigecycline,Mikacin was more sensitive,and other strains resistance rates were higher.The isolation rate of Gram-positive cocci was 25.3%,mainly Staphylococcus aureus,Enterococcus faecium and Streptococcus,except for vancomycin,linezolid,quinupristin/dalfopristin,tigecycline was more sensitive,and other strains resistance rates were higher.The isolation rate of fungi was 3.2%,all of which were Candida,and all of them were insensitive to itraconazole.Multivariate Logistic regression analysis showed that older age,acute lymphoblastic leukemia,sepsis or septic shock were independent risk factors for the prognosis of AL patients with BSI.Conclusion The main pathogenic bacteria causing BSI in AL patients are gram-negative bacilli,and meropenem,piperacillin/tazobactam and tigecycline should be used for anti-infection treatment;vancomycin,linezolid and tigecycline should be used in the treatment of gram-positive bacterial infection.
作者
安淑娟
刘蓓
AN Shujuan;LIU Bei(Department of Clinical Laboratory,Lanzhou University First Hospital,Lanzhou,Gansu 730000,China;Department of Hematology,Lanzhou University First Hospital,Lanzhou,Gansu 730000,China)
出处
《检验医学与临床》
CAS
2022年第17期2336-2340,共5页
Laboratory Medicine and Clinic
基金
甘肃省科技厅自然科学基金项目(18JR3RA356)
关键词
急性白血病
血流感染
病原菌
耐药性
预后因素
acute leukemia
bloodstream infection
pathogenic bacteria
drug resistance
prognostic factors
