白血病合并感染患者细菌分布、耐药情况及死亡危险因素分析

目的了解白血病合并感染患者细菌分布特征、细菌耐药情况及死亡危险因素。方法选取2015年1月-2019年12月于徐州医科大学附属医院住院治疗的白血病合并感染患者168例,收集其临床资料,使用WHONET 5.6和SPSS 19.0软件对细菌种类、耐药情况等资料进行统计分析。应用Logistic回归分析确定死亡危险因素。结果白血病合并感染患者168例共分离出细菌472株,革兰阴性菌占比73.1%,革兰阳性菌占比26.9%。排名居前3位的细菌依次为大肠埃希菌(28.1%)、肺炎克雷伯菌(19.1%)和铜绿假单胞菌(18.8%)。铜绿假单胞菌对头孢曲松的耐药率高达100.0%,金黄色葡萄球菌对苯唑西林的耐药率为50.0%,对万古霉素、替考拉宁和利奈唑胺未产生耐药。血清白蛋白水平(OR=0.879,95%CI 0.776-0.996,P=0.044)、嗜麦芽窄食单胞菌感染(OR=2.726,95%CI 1.241-3.095,P=0.005)与白血病患者病死率相关。结论感染是白血病患者最常见的并发症和死亡危险因素。了解致病菌株及耐药性,加强对白血病合并细菌感染患者的护理,对白血病感染患者进行合理的经验性治疗。

Analysis of bacterial distribution,resistance and risk factor of death of bacterial infection in leukemia patients

Objective To investigate the characteristics of bacterial distribution, resistance and risk factor of death of bacterial infection in leukemia patients. Methods The clinical data of 168 leukemia inpatients complicated by bacterial infection admitted to the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2019 were collected. WHONET 5.6 and SPSS 19.0 software were used to count the bacterial species, resistance, etc. Logistic regression was used to analyze the risk factor of death. Results A total of 472 bacterial strains were isolated from serum of those 168 patients, the accounted of gram-negative bacterium and gram-positive bacterium were 73.1% and 26.9% respectively. Escherichia coli (28.1%) was most common among bacterium, followed by Klebsiella pneumoniae (19.1%) and Pseudomonas aeruginosa (18.8%). The highest resistance rates were Pseudomonas aeruginosa against ceftriaxone with the rate of 100%, the resistance rates were Staphylococcus aureus against oxacillin with the rate of 50%, and there was no resistance against vancomycin, teicoplanin and linezolid. Serum albumin level (OR=0.879, 95%CI 0.776-0.996, P=0.044) and stenotrophomonas maltophilia infection (OR=2.726, 95%CI 1.241-3.095, P=0.005) were associated with mortality in leukemic patients. Conclusion Bacterial infection is the most common complication and risk factor of death in leukemic patients. By understanding the pathogenic strain and resistance, strengthen the care of patients, and so as to carry out reasonable empirical treatments.