恶性血液病的医院感染

目的:探讨恶性血液病(HM)院内感染(NI)的危险因素,临床意义和治疗。方法:回顾153例HM的NI,比较粒缺组与非粒缺组的医院感染率(NIR)、死亡率、院内感染持续时间、感染部位。20例曾用泰能治疗。31例患者化疗后2d～14d外周血WBC<2.0×10~9/L时给用G-CSF,剂量为75～150mg/d。8例严重NI患者使用静脉免疫球蛋白(IVIg)治疗。结果:NIR为52.9％,粒缺组与非粒缺组NIR分别为87.2％和41.2％;平均感染时间分别为19.2d和8.8d”死亡为6例和1例;呼吸系统是最常见感染部位;泰能治疗有效率为55％;化疗后严重白细胞减少率:用G-CSF组为45.2％,对照组为87.1％;NIR分别为54.8％和90.3％。结论:粒细胞缺乏是发生NI的高危因素;泰能是有效而副作用小的药物;化疗后用G-CSF可以缩短粒细胞减少时间,帮助病人度过NI危险期,早期用G-CSF比晚期用好;IVIg的使用有待研究观察。

Nosocomial Infetio in Hematologic Malignancies

Object: To evaluate the risk factors, clinical significance and treatment of noscomial infection (NI) in hematologic malignancies (NM). Methods: NI of HM has been reviewed retrospecively in 153 patients. Comparing difference between agranulocy-tosis and Nonagranulocytosis in nosocomial infectious rate (NIR), morbidity, average duration of NI, Location of infection. There were 20 patients treated by Imipenem/cilastain (Tienam). 31 patients were administrated G ~ CSF, 75 ~ 150 mg/d from 2 to 14 days after chemotherapy when WBC<2000/ul. there were 8 severe patients of NI to treat with intravenous immunoglobulins (IVIG) except antibiotics. Results: The overall NIR of HM was 52. 9 % . NIR of agranulocytosis and non-agranulocytosis were 87. 2 % and 41.2 % , respectively. The average duration of NI were 19.2 days for former and 8. 8 days for latter (P<0. 001). 6 cases (15. 4 %) and 1 case (0.9 %) died of NI, respectively (P<0.005). Respiratory system was most common infected. The overall clinical effective rate of Tienam was 55 % . During administration of G-CSF to NI patients following cytotoxic chemotherapy, it was found that the severe neutropenia rate was 45.2 % (14/31) and control group was 87. 1 (27/31) (P<0.005). NIR was 54.8% (17/ 31) for former and 90. 3 % (28/31) for latter. Conclusions: Agranulocytosis was the main risk factor of NI in HM. Tienam was well tolerated with few side effects. After administration of G-CSF to patients of agranulocytosis following cytoxic chemotheray. it was found that the duration of neutropenia was shorted and helped the patients through critical phase of NI. Administration of G-CSF was better early than late. The role of IVIG in the NI of HM needs further studies.