造血干细胞移植后早期感染29例临床分析

目的了解儿童脐血及外周血造血干细胞移植早期感染发生的情况及其影响因素.方法采用回顾性的临床统计,分析了造血干细胞移植早期感染的29例病例的临床资料.结果 31例造血干细胞移植患儿移植后早期感染的发生率为94%(29例).首次发生移植早期感染的时间为0～+22 d(移植后为"+"),中位时间+6.2 d,高峰时间为+4～+7 d;感染持续时间为3～20 d,中位时间8.9 d.二次感染的8例感染发生的时间为+13～+27 d,中位时间+18.8 d.所有29例患儿首次感染均发生在中性粒细胞绝对计数>0.5×109/L之前,移植后的WBC数量的恢复情况与移植后早期感染的发生和持续时间密切相关.移植早期感染最常见为口腔炎、胃肠炎等消化道粘膜炎,其次为呼吸道感染;本组病例血培养以G革兰阴性杆菌阳性率最高.移植早期预防性使用泰能较对照[(+4.7±2.1) d]可推迟首次感染发生的时间[(+8.6±5.1 )d].结论移植后早期感染发生的高峰时间为+4～+7 d,感染持续时间为3～20 d,中位时间8.9 d;主要为消化道粘膜炎及呼吸道感染;血培养阳性细菌以革兰阴性杆菌为主.移植前预防性使用亚胺培南+西司他丁(商品名泰能)可以推迟移植后早期感染的发生时间,对移植早期感染的预防有一定的效果.

Clinical analysis of 29 children with early infectious complications following hematopoietic stem cells transplantation

OBJECTIVE: To study the clinical features and the incidence of early infectious complications following children hematopoietic stem cells transplantation (HSCT). METHODS: The clinical data of 29 cases with early infectious complications following HSCT was retrospectively analyzed. RESULTS: The incidence of early infectious complications following HSCT in 31 children (including 22 cord blood transplantation and 9 peripheral blood stem cells transplantation) was 94% (29/31). The first occurrence of the early infectious complications was at a median of 6 (0 - 22) days, the peak time of incidence was at a median of 4 - 7 days post transplantation. The duration of the first early infectious complications was at a median of 9 (3 - 20) days. The occurrence of the second early infectious complications was at a median of 19 (13 - 27) days. For all of the 29 children, when they developed early infectious complications their absolute neutrophil counts (ANC) were all > 0.5 x 10(9)/L. The most common infectious sites were the digestive tract (oral and gastro-intestinal mucositis) and then the respiratory tract. Gram negative blood infections were quite frequent and Pseudomonas aeruginosa was common in the oral-pharynx discharge cultures. Two children had Mycoplasma pneumonia infections and there were 4 incidences with fever but no definite infectious foci. The incidence and duration of early infectious complications following hematopoietic stem cells transplantation were associated with the duration of neutropenia. The source and the MNCs dose of the graft, the difference of conditioning regimen and GVHD prophylaxis method did not have a significant impact on the incidence and duration of early infectious complications. Antibiotic prophylaxis (including Tienam) could delay the occurrence of the early infections significantly. CONCLUSION: The incidence and duration of early infectious complications following hematopoietic stem cells transplantation were directly associated with the duration of neutropenia. Tienam regimen could postpone the early infections incidence and had effect of preventing the early infectious complications.