成人灰色小克银汉霉侵袭性毛霉菌病1例并文献复习

目的 探讨灰色小克银汉霉感染导致成人毛霉菌病患者的临床特点及诊治方案。方法 总结某院血液内科收治的1例灰色小克银汉霉感染致成人侵袭性毛霉菌病患者的临床诊疗过程,并检索数据库相关文献进行复习。结果 患者男性,54岁,因“反复乏力1年余,加重伴发热1周”入院,肺组织病理检查可见宽大、不规则、无分隔的菌丝,形态学鉴定为毛霉菌,肺泡灌洗液及外周血宏基因组二代测序(mNGS)检测示灰色小克银汉霉,诊断为灰色小克银汉霉感染致侵袭性毛霉菌病,给予脂质体两性霉素B联合泊沙康唑、卡泊芬净治疗后感染获得控制。检索出符合条件的文献37篇,加上本病例,共纳入44例患者,其中男性26例,女性18例,中位年龄52.5(18～79)岁;基础疾病主要为血液系统疾病(65.9%,29例),进行造血干细胞或实体器官移植者14例;最常见的侵犯部位为肺、脑及皮肤,分别为36、9、9例;组织病理学、真菌培养、直接镜检及分子学检测阳性者分别为28、37、29、17例。41例患者接受了抗真菌治疗,其中8例联合手术治疗;30例死亡,病死率为68.2%,抗真菌治疗联合手术者生存率(62.5%,5/8)高于单独抗真菌治疗者(24.2%,...     

Candida bloodstream infection in patients with systemic autoimmune diseases

ObjectivesTo describe the epidemiological, clinical and microbiological characteristics and mortality of patients with Candida bloodstream infection and systemic autoimmune diseases.MethodsWe performed a retrospective multicenter study of candidemia in adults with systemic autoimmune diseases between 2010 and 2016.ResultsAmong 1040 patients with candidemia, 36 (3.5%) had a systemic autoimmune disease. The most common systemic autoimmune disease was rheumatoid arthritis (27.8%). The most common species was Candida albicans (66.7%). Twenty-two (61.1%) patients received a corticosteroid therapy and nine (25%) received an immunosuppressive therapy at the time of candidemia. The mortality rate was 27.8%.ConclusionsSystemic autoimmune diseases are not common in patients with candidemia. The unadjusted mortality rate was comparable to other candidemia studies in the general population.     

血液肿瘤患儿深部真菌感染诊断和治疗的临床分析

目的 探讨血液肿瘤患儿深部真菌感染的临床特征及其诊断和治疗.方法 回顾性分析2006年1月～2011年10月210例血液肿瘤经微生物学检查证实深部真菌感染患儿的相关诱因、临床特点、真菌培养结果和治疗方案并进行分析.结果 210例患儿从血或深部分泌物中共分离出168株菌种,其中念珠菌134株,占79.7％,包括白色念珠菌102株,热带念珠菌株23,近平滑念珠菌9株;曲霉菌27株,占16.1％;假丝酵母菌5株,占3.0％;毛霉菌2株,占1.2％.其余42例根据典型的影像学改变和治疗效果诊断为真菌感染.感染部位以肺部最常见,占69.5％,主要表现为咳嗽、咯痰、气促、喘憋,CT可见大片结节状或团块状高密度影;其次为肠道和泌尿系统,分别占14.9％和10.1％,其他还有败血症和皮肤感染.210例患儿全部行抗真菌药物治疗,同时加强对症支持治疗,其中单用氟康唑者83例,单用伊曲康唑者56例,单用两性霉素B者38例,其余33例联合或先后应用上述药物治疗.治愈66例,好转78例,恶化死亡42例,24例因原发病未缓解自动出院.结论 血液肿瘤患儿深部真菌感染诊断困难,最常见的感染部位为肺部,最常见的病原菌为念珠菌和曲霉菌.对于粒细胞减少发热患者抗生素治疗无效时,应及早行肺部CT检查.     

Hepatitis G virus/GBV-C in serum,peripheral blood mononuclear cells and bone marrow in patients with hematological malignancies

BackgroundHGV/GBV-C is highly prevalent in the general population but its significance remains unclear. It is known that HGV/GBV-C is not primary hepatotropic and its replication was reported in PBMC, bone marrow and other tissues. To investigate a possible role of HGV/GBV-C 115 consecutive patients with hematological malignancies were analyzed for virus RNA presence and quasispecies composition in three compartments: serum, PBMC and bone marrow.MethodsRT-PCR was used to amplify 5′UTR HGV/GBV-C in serum, PBMC and bone marrow. Viral sequences obtained from three compartments were subjected for comparative molecular analysis performed by single strand conformational polymorphism (SSCP) and pyrosequencing.ResultsHGV/GBV-C RNA was detected in 23 out of 115 (20.0%) patients, most often in bone marrow (18 patients), followed by PBMC (11 patients) and serum (10 patients). Differences in SSCP bands distribution corresponding to different viral variants and confirmed by direct sequencing were observed in three patients.ConclusionHGV/GBV-C infection is frequent in patients with hematological malignancies. Common detection of HGV/GBV-C in bone marrow supports the hypothesis that it is a major replication site of this virus.     

Differential loss of humoral immunity against measles,mumps, rubella and varicella-zoster virus in children treated for cancer

BackgroundIntensive chemotherapy in children with cancer results in long-term impairment of humoral immunity. Whereas most studies to date focused on children with acute lymphoblastic leukemia (ALL), little data have been published on patients suffering from Hodgkin disease or from solid tumors. We therefore analyzed the loss of protective immunity (defined as immunity at the time of diagnosis and lack of immunity after completion of therapy) against vaccine-preventable diseases in children treated for various malignancies.MethodsChildren and adolescents <21 years of age at diagnosis and treated between 2001 and 2010 for various malignancies in the Department of Pediatric Hematology and Oncology, University of Frankfurt, were included in the retrospective chart review. Antibody levels against measles, mumps, rubella and varicella-zoster-virus (VZV) were routinely assessed at the time of diagnosis and within 12 months after completion of therapy.ResultsThe study population consisted of 195 children (122 male); 80 patients had ALL, 15 acute myelogenous leukemia (AML), 18 non-Hodgkin lymphoma (NHL), 22 Hodgkin disease, and 60 various solid tumors. Overall, 27%, 47%, 19%, and 17% of the patients lost their humoral immunity against measles, mumps, rubella, and VZV, respectively. The risk of losing protective antibody titers depended on age with a higher risk in younger children. The loss of protective humoral immunity occurred significantly more often in patients with ALL compared to patients with any other underlying malignant disease (hematological malignancies such AML and NHL, Hodgkin disease or solid tumors).ConclusionsOur data demonstrate that a significant number of children lose pre-existing humoral immunity against measles, mumps, rubella, and VZV after completion of chemotherapy. This loss occurs more often in children with ALL than in children with AML, solid tumors and Hodgkin disease. Our results underline the need for post-chemotherapy revaccination of childhood cancer survivors.     

Ibrutinib,a Bruton's tyrosine kinase inhibitor,a new risk factor for cryptococcosis

PurposeInvasive fungal diseases and especially Cryptococcus neoformans infections are increasingly reported in patients with hematological malignancies receiving ibrutinib, a Bruton's tyrosine kinase inhibitor.Patients and methodWe reported three additional cases and reviewed 16 previous published cases together with cases from the international pharmacovigilance database.ResultsPatients were mainly treated for chronic lymphocytic leukemia. Cryptococcosis mostly occurred during the first six months (66%) and especially the first two months (44%) of treatment. Clinical presentation is often pulmonary (68%) and the outcome is usually favorable despite ibrutinib continuation.ConclusionClinicians must be aware of this infection in patients with hematological malignancies on ibrutinib.     

The Spectrum of Sickle Cell Disease

Abstract

Since its discovery in 1982, Helicobacter pylori has been established as a common cause of gastritis and peptic ulcer disease. H pylori infection is also closely associated with several gastric malignancies and has consequently been designated a human carcinogen. As these associations have become increasingly recognized and pursued, a growing challenge facing today's clinicians is the management of patients with persistent H pylori despite previous attempts to treat the infection. In developed countries, the most popular treatment regimen remains traditional triple therapy consisting of a proton pump inhibitor, clarithromycin, and amoxicillin for 7 to 14 days. Unfortunately, eradication rates with traditional triple therapy are disappointing, with infection persisting in as many as 25% of those treated. This article addresses the management of patients with persistent H pylori infection, including indications for confirmatory testing, reasons for treatment failure, and established and emerging salvage regimens for patients with persistent infection.     

替加环素治疗血液系统恶性肿瘤并发感染的疗效及其影响因素

目的 探讨替加环素治疗血液系统恶性肿瘤并发感染的疗效及其影响因素,为临床合理用药提供参考。 方法 回顾性分析某院血液系统恶性肿瘤并发感染且应用替加环素患者的临床资料,评价替加环素治疗的临床疗效,利用单因素分析和多因素logistic回归分析影响患者疗效的因素。 结果 共纳入182例患者,85例（46.7%）患者原发疾病为急性髓系白血病,粒细胞缺乏者116例（63.7%）,感染部位主要为肺部（72.0%）。分离病原菌62株,其中8株为耐碳青霉烯类肠杆菌目细菌。113例（62.1%）患者使用高剂量替加环素,疗程为（11.6±6.5）d,临床总有效率为55.5%。多因素分析结果显示,社区获得性肺炎、粒细胞缺乏时间>14 d和替加环素疗程 < 7 d是治疗失败的独立危险因素,治疗效果与患者性别、年龄、原发疾病、替加环素剂量、联合用药及感染病原菌无关。 结论 替加环素对血液恶性肿瘤并发感染患者有较好的疗效,但社区获得性肺炎、粒细胞缺乏时间>14 d和替加环素疗程 < 7 d会明显影响其疗效。     

Attitude,knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency

BackgroundImmunocompromised patients are at increased risk for severe influenza and invasive pneumococcal diseases. Population-specific vaccine recommendations are thus warranted. This study aimed to estimate the prevalence and predictors of influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency.MethodsAn anonymous online survey was submitted to the members of 11 French associations of immunocompromised patients. The questionnaire included questions concerning underlying disease, care and treatment, flu and pneumococcal vaccine uptake, attitudes and knowledge about vaccination. Factors associated with vaccine uptake were assessed by multivariate logistic regression.ResultsAmong the 10,897 solicited patients, 3653 agreed to participate (33.5%): 75% were female, 20% aged 65+, 79% were followed for an autoimmune disease, 13% were solid organ recipients or waiting for transplantation and 8% were treated for hematological malignancies. 3109 (85%) participants were treated with immunosuppressive therapy. Self-reported vaccine uptake was 59% (95%CI [57–60]) against seasonal influenza and 49% (95%CI [47–50]) against pneumococcal diseases. Better knowledge of and favorable attitudes toward vaccination were positively associated with vaccine uptake while being treated with a biological therapy was negatively associated.ConclusionDespite specific recommendations regarding immunocompromised patients, influenza and pneumococcal vaccination rates do not reach recommended levels. Targeted information campaigns on vaccination toward these populations should be implemented to improve vaccine coverage and thus reduce the burden of infections.     

Clinical Presentation of COVID19 in Dementia Patients

Objective

No studies analyzing the role of dementia as a risk factor for mortality in patients affected by COVID-19. We assessed the prevalence, clinical presentation and outcomes of dementia among subjects hospitalized for COVID19 infection.

Design

Retrospective study.

Setting

COVID wards in Acute Hospital in Brescia province, Northern Italy.

Participants

We used data from 627 subjects admitted to Acute Medical wards with COVID 19 pneumonia.

Measurements

Clinical records of each patients admitted to the hospital with a diagnosis of COVID19 infection were retrospectively analyzed. Diagnosis of dementia, modalities of onset of the COVID-19 infection, symptoms of presentation at the hospital and outcomes were recorded.

Results

Dementia was diagnosed in 82 patients (13.1%). The mortality rate was 62.2% (51/82) among patients affected by dementia compared to 26.2% (143/545) in subjects without dementia (p<0.001, Chi-Squared test). In a logistic regression model age, and the diagnosis of dementia resulted independently associated with a higher mortality, and patients diagnosed with dementia presented an OR of 1.84 (95% CI: 1.09–3.13, p<0.05). Among patients diagnosed with dementia the most frequent symptoms of onset were delirium, especially in the hypoactive form, and worsening of the functional status.

Conclusion

The diagnosis of dementia, especially in the most advanced stages, represents an important risk factor for mortality in COVID-19 patients. The clinical presentation of COVID-19 in subjects with dementia is atypical, reducing early recognition of symptoms and hospitalization.

     

Validation of the EORTC QLQ-INFO 25 questionnaire in Lebanese cancer patients: Is ignorance a Bliss?

Introduction

Despite worldwide trends toward optimizing full disclosure of information (DOI), the prevailing belief that cancer diagnosis should be concealed from patients, for their own good, has endured for a substantial period of time in Middle Eastern communities.

Objectives

This study would assess the reliability of the Arabic translated version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-INFO 25). The study was also designed to quantify DOI to Lebanese cancer patients and determine patient satisfaction with this DOI. Moreover, we compared the differences in the level of information among groups based on clinical and biographical variables.

Methods

A sample of patients, being treated for a variety of malignancies, was prospectively evaluated. A physician interviewed patients using the Arabic version of the EORTC QLQ-INFO 25, on the day of hospitalization for chemotherapy, before treatment was administered.

Results

In total 201 patients were interviewed. The translated version of the EORTC QLQ-INFO 25 showed high reliability when assessed using Cronbach’s alpha coefficients for internal consistency with values scoring higher than 0.7 for all scales and the full questionnaire. There was a considerable lack of information provided to the participants with 38.8 % being unaware of their diagnosis and more than half being uninformed about the extent of their disease. Paradoxically, 86.5 % of patients expressed their satisfaction about the amount of information they received and 89.5 % believe the information provided was helpful. Further analysis showed no significant association between gender, marital status, cancer site and stage and the amount of information received. However, age and level of education were associated with DOI such as younger and more educated patients received more information. Older patients were also found to be the most satisfied with the information they received, despite having less access to information.

Conclusions

Although a high proportion of patients were not properly informed about their diagnosis, the overwhelming majority were satisfied with the amount of information they received and believed it was useful, reflecting the complexity of Middle Eastern cultural influences on cancer patients’ perspectives.

     

伏立康唑治疗老年恶性血液病侵袭性真菌感染疗效分析

目的 探讨伏立康唑在老年恶性血液病侵袭性真菌感染患者中的临床疗效及不良反应.方法 对2007年5月-2011年12月的50例老年恶性血液病侵袭性真菌感染患者的临床资料进行回顾性分析.结果 确诊4例,临床诊断20例,拟诊26例;14例患者为初始治疗,36例患者为挽救治疗;总有效率为74.0％,确诊组4例均有效,临床诊断组有效率70.0％,拟诊组有效率73.1％;初始治疗有效率85.7％,挽救治疗有效率69.4％;经过静脉注射的患者有效率76.3％,单纯口服治疗有效率66.7％,两组差异无统计学意义;10例患者曲霉菌属感染,6例有效,曲霉菌属清除;粒细胞缺乏影响伏立康唑疗效,粒细胞缺乏组有效率58.4％,低于无粒细胞缺乏组的88.5％(P＜0.05);主要不良反应为肝功能异常、视觉障碍、幻觉,停药后可消失,未观察到肾毒性及心脏毒性. 结论 伏立康唑可安全有效地治疗老年恶性血液病侵袭性真菌感染.     

Hematological malignancies: Incidence in Basse-Normandie,France, for 1997–2004

BackgroundThis study was designed to present the incidence of all the hematological malignancies in Basse-Normandie for 1997–2004. We extracted the data from the Registre régional des hémopathies malignes de Basse-Normandie (RRHMBN), a French registry which belongs to the Association of the French Cancer Registries (FRANCIM).MethodsAll the malignant hematological diseases were coded using the third edition of the International Classification for Oncologic Diseases (ICDO-3) and the ADICAP classification, a special version adapted in 2001 for hematology. A total of 5510 new cases of malignant hematological disorders were registered over the 1997–2004 period. No significant difference in incidence was detected for any of the departments making up the Basse-Normandie region (Calvados, Manche and Orne). In men, the most frequent malignant disorders were non-Hodgkin malignant lymphomas (NHML) followed by chronic lymphocytic leukemia and other mature neoplasms, myelodysplastic syndromes (MDS), multiple myelomas (MM), myeloproliferative syndromes (MPS), acute myeloid leukemias (AML), Hodgkin lymphomas (HL), Waldenström macroglobulinemia (WM), and acute lymphoblastic leukemia (ALL). In women, MM is the third most frequent hematological disorder after NHML and lymphocytic leukemia followed by other mature neoplasms, MPS, MDS, AML, HL, WM, and ALL. The other hematological disorders are very rare.ResultsWe provide the incidence for the main hematological disorders and for the first time present the incidence of the different subtypes of the HL and NHML, mature lymphoid neoplasms, MPD, and MDS. These results are useful for the organization and follow-up of medical care. The development of specialized hematology and active protocols can optimize the management of older patients. High-quality data remain necessary for continuous monitoring and research on patients with malignant hematological diseases.     

血液肿瘤患者医院获得性感染细菌病原学研究

目的 探讨血液肿瘤患者化疗后粒细胞缺乏期，医院感染的细菌病原学特点及体外对抗生素的敏感性，为临床抗生素应用提供参考。方法 化疗后粒细胞缺乏期出现感染性发热患者，在应用抗生素前留取血，痰、尿及分泌物标本，体外分离细菌菌株并测定对抗生素的敏感性。结果 医院感染细菌以G^-杆菌多见，大肠埃希菌，肺炎克雷伯菌，铜绿假单胞菌是最常见的致病菌，鲍曼不动杆菌有逐年增加的趋势；G^ 球菌感染主要为肠球菌属；体外药敏试验显示耐药菌株近年来有增加趋势，大多数G^-杆菌对半合成青霉素耐药，5%左右肠球菌对万古霉素耐药。结论 在化疗后粒细胞缺乏的患者医院感染的细菌主要为内源性菌，耐药菌株增加，其原因与大量广谱抗生素应用及医院交叉感染有关。     

Evaluation of Cheek Edema in an Infant Reveals Langerhans Cell Histiocytosis

BackgroundLangerhans cell histiocytosis is a rare hematological disorder. Skin rash is the typical early feature, and bony involvement is the second most common presentation.MethodsWe present a case of a 5-month-old female infant with left hemifacial swelling, initially treated for infection with antibiotics. However, due to persistence of swelling and new onset fever, further evaluation with ultrasonography, CT scan, FDG PET/CT and eventually biopsy was performed.ResultsImaging methods revealed mandibular osteolysis indicative of either osteomyelitis or histiocytosis X. Tissue biopsy was diagnostic for Langerhans cell histiocytosis.ConclusionLangerhans cell histiocytosis may present in infancy with a variety of symptoms, included an isolated bony lesion. Langerhans cell histiocytosis, despite its rarity, should be included in the differentiated diagnosis, when bone osteolysis is found.     

Nutrition and Swallowing Therapy in Head and Neck Cancer: Utilization of Care and Preventative Efficacy

Purpose: To examine the impact of ethnicity, Spanish language preference, socioeconomic status, and treatment setting on utilization of supportive services before radiotherapy (RT) among head and neck cancer patients and to determine whether a lack of these services is associated with an increased rate of adverse events.

Methods and Materials: Demographic, staging, and treatment details were retrospectively collected for patients treated at a safety-net hospital (n?=?56) or adjacent private academic hospital (n?=?183) from January 1, 2014, to June 30, 2016. Supportive care services evaluated were limited to speech/swallowing therapy and nutrition therapy. Adverse events and performance measures examined included weight loss during RT, gastric tube placement, emergency department visits, hospital admissions, and missed RT days.

Results: On multivariable analysis, patients receiving treatment at the safety-net hospital were less likely to receive speech/swallowing services. Receiving speech/swallowing therapy before treatment was associated with less weight loss during treatment, and in conjunction with nutrition therapy, was associated with fewer missed RT days.

Conclusion: Safety-net hospital treatment was associated with a lack of utilization of pre-RT speech/swallowing therapy which in turn was associated with increased weight loss. Interventions aimed at improving utilization of these services would improve treatment tolerance and patient outcomes.     

Antifungal prophylaxis with low doses fluconazole in patients with hematological malignancies

INTRODUCTION: The incidence of mycotic infections in immunocompromised patients has reached a 20-fold rise for the last two decades. AIM: The goal of the study was to evaluate fluconazole efficacy as antifungal prophylaxis in patients with hematological malignancies. MATERIAL AND METHODS: Sixty nine patients with hematological malignancies and neutrophil count less than 1.0 x 10(9)/L received fluconazole orally at a dose of 150 mg every other day. Fluconazole was discontinued when a neutrophil count above 1.5 x 10(9)/L was maintained. Duration of neutropenic periods, afebrile cycles, and incidence of mycotic infections were assessed. The same variables were observed in a control group of 41 patients who did not receive antifungal prophylactic therapy. RESULTS: Both groups were similar in the mean duration of neutropenic period but the afebrile cycles in the patients receiving antifungal prophylaxis were longer by 5 days compared to these in the patients without prophylaxis. The mycotic infections had lower incidence in the patients on antifungal prophylaxis and the difference was statistically significant (p < 0.01). The superficial mycotic infections composed the majority of the clinically and/or microbiologically verified infections. These were presented by oropharyngeal infection (61%), esophageal (22%), and single cases of skin, genital or rectal infections. Candida albicans was isolated in 85% of the cases. The adverse reactions of fluconazole therapy were mild, transient, and easily manageable. No signs of liver and renal dysfunction were observed. CONCLUSION: Lower dose of fluconazole, 150 mg every other day p.o., has the same antifungal effect as a dose of 200 mg/day p.o. in neutropenic patients with hematological malignancies which lowers the cost of treatment.     

Observational study of vaccination in cancer patients: How can vaccine coverage be improved?

BackgroundChemotherapy increases the risk of infections, often severe, and some of them are vaccine-preventable infections. We aimed to assess vaccination coverage and associated factors in oncology and hematology patients.MethodsConsecutive adult patients followed in a French university hospital for hematological malignancy or solid cancer voluntarily completed an anonymous questionnaire in September and October 2016. It included questions on underlying disease, chemotherapy, flu, and pneumococcal vaccination uptakes, and attitudes toward vaccination. Factors associated with vaccination uptake were assessed by multivariate logistic regression.ResultsThe response rate was 41.9% (N = 671) among 1,600 questionnaires distributed; 232 patients had underlying hematological malignancy and 439 had solid cancer. Half of the patients were aged over 65 years. Chemotherapy was ongoing or discontinued for less than one year in 74.7% of patients. In patients aged < 65 years undergoing chemotherapy, flu vaccination rate was 19.9% whereas patients aged > 65 years had coverage of 47%. Pneumococcal vaccine uptake was 7.3%. However, 64.7% of patients were favorable to vaccination. Vaccine uptake was associated with age > 65 years (OR 4.5 [2.9–7.0]), information about vaccination delivered by the family physician (OR 12.9 [5.5–30.1]), follow-up in hematology unit (OR 2.0 [1.3–3.1]), and positive opinion about vaccination (OR 2.0 [1.3–3.1]).ConclusionDespite specific recommendations regarding immunocompromised patients, anti-pneumococcal and flu vaccinations were rarely conducted, even in elderly patients. Targeted information campaigns to family physicians, oncologists, and patients should be implemented to improve vaccine coverage in patients with underlying malignancies.     

集束化干预预防恶性血液病患者医院感染的效果

目的探讨集束化干预措施预防恶性血液病患者医院感染的效果,为恶性血液病患者医院感染预防措施的制定提供依据。方法采用回顾性和前瞻性调查相结合的方法,选择某医院血液科住院治疗的恶性血液病患者为研究对象,以2017年1月1日—2018年1月31日进行常规干预的患者为对照组,2018年2月1日—9月20日进行集束化干预的患者为试验组,比较两组患者在治疗过程中,集束化干预前后医院感染发病率以及感染部位的变化。结果试验组恶性血液病患者医院感染发病率为8.18%(28/342),低于对照组的17.40%(75/431),差异有统计学意义(P0.05)。进一步对恶性血液病患者进行归类分析,结果显示,与对照组比较,试验组淋巴瘤患者医院感染发病率降低最明显(28.85%VS 9.80%),其次为急性白血病患者(24.42%VS 13.27%),集束化干预前后两种疾病患者医院感染发病率比较,差异均有统计学意义(均P0.05);淋巴瘤和急性白血病患者医院感染部位构成比发生明显变化,两者在呼吸系统、口腔和软组织等部位的感染构成比均有所下降,而血液感染构成比呈上升趋势。结论采取集束化干预措施,能降低恶性血液病患者医院感染发病率。