摘要
目的分析血液病患者并发血流感染的病原菌分布特点及感染危险因素。方法采集患者静脉血标本,全自动血培养仪培养,阳性标本采用全自动细菌鉴定仪鉴定,回顾性分析病例的详细临床资料、血培养结果。结果122例血液病并发血流感染患者,男性68例,女性54例。年龄17~79岁,住院天数2~143 d。原发血流感染48例,继发性血流感染74例。急性淋巴细胞白血病43例,急性髓系白血病31例,多发性骨髓瘤12例,非霍奇金淋巴瘤8例,骨髓增生异常综合征6例,再生障碍性贫血慢性粒细胞性白血病6例,缺铁性贫血5例,非霍奇金淋巴瘤4例,其他血液病7例。35例合并其他部位感染,主要为伴肺部感染(13.93%)。共检出病原菌145株,其中革兰阴性菌78株,革兰阳性菌59株,真菌8株。革兰阴性菌主要以肺炎克雷伯菌(19.31%)、大肠埃希菌(8.97%)、铜绿假单胞菌(6.89%)为主。革兰阳性菌主要以凝固酶阴性葡萄球菌(12.41%)、金黄色葡萄球菌(8.28%)为主。真菌主要为热带假丝酵母菌(2.07%)、白色假丝酵母菌(2.07%)。嗜麦芽窄食单胞菌对甲氧苄啶-磺胺甲口恶唑、左氧氟沙星、米诺环素、头孢吡肟、复方新诺明和头孢哌酮-舒巴坦耐药率依次为:60.00%、60.00%、20.00%、0.00%、40.00%和40.00%。对感染组和对照组进行单因素分析,年龄、住院天数、抗感染药物使用种类、粒细胞缺乏时间、中性粒细胞值、化疗、侵入性操作、合并其他部位感染在感染组和对照组间差异有统计学意义(P<0.05)。多因素logistic分析发现,年龄>60岁、住院天数>30 d、粒细胞缺乏时间>7 d、侵入性操作、合并其他部位感染,是血液病患者发生血流感染的独立危险因素。结论血液病并发血流感染主要以原发血流感染为主,以革兰阴性菌为主要病原菌,年龄大、住院天数长、粒细胞缺乏时间久、接受过侵入性治疗、合并其他部位感染是引发血流感染的危险
Objective To analyze the distribution of pathogenic bacteria and the risk factors of infection in patients with hematological diseases complicated with bloodstream infection.Methods Venous blood samples were collected from patients participating in this study and cultured with automatic blood culture instrument.Positive samples were identified by automatic bacterial identification instrument.The detailed clinical data,and blood culture results of patients participating in the study were retrospectively analyzed.Results There were 122 patients with hematological diseases complicated with bloodstream infection,including 68 males and 54 females.The age ranged from 17 to 79 years,and the length of hospital stay was 2 to 143 days.There were 48 cases of primary bloodstream infection and 74 cases of secondary bloodstream infection.There were 43 cases of acute lymphoblastic leukemia,31 cases of acute myeloid leukemia,12 cases of multiple myeloma,8 cases of non Hodgkin’s lymphoma,6 cases of myelodysplastic syndrome,6 cases of aplastic anemia,chronic granulocytic leukemia,5 cases of iron deficiency anemia,4 cases of non Hodgkin’s lymphoma and 7 cases of other hematological diseases.35 cases were complicated with other site infection,mainly with pulmonary infection(13.93%).A total of 145 strains of pathogenic bacteria were detected,including 78 Gram-negative bacteria,59 Gram-positive bacteria and 8 fungi.Gram negative bacteria were mainly Klebsiella pneumoniae(19.31%),Escherichia coli(8.97%)and Pseudomonas aeruginosa(6.89%).Gram positive bacteria were mainly coagulase negative staphylococci(12.41%)and Staphylococcus aureus(8.28%).The main fungi were Candida tropicalis(2.07%)and Candida albicans(2.07%).The resistance rates of Stenotrophomonas maltophilia to trimethoprim sulfamethoxazole,levofloxacin,minocycline,cefepime,cotrimoxazole and cefoperazone sulbactam were 60.00%,60.00%,20.00%,0.00%,40.00%and 40.00%respectively.Through univariate analysis of the infection group and the control group,it was found that there were
作者
梁波
尹俊杰
张胜楠
张超
胡子龙
王怡
LIANG Bo;YIN Jun-jie;ZHANG Sheng-nan;ZHANG Chao;HU Zi-Long;WANG Yi(Xinxiang Central Hospital,The Fourth Clinical College of Xinxiang Medical University,Xinxiang,Henan 453000,China)
出处
《中国病原生物学杂志》
CSCD
北大核心
2022年第8期929-933,共5页
Journal of Pathogen Biology
关键词
血液病
血流感染
病原菌
危险因素
hematopathy
blood stream infection
pathogenic bacteria
risk factors
