中性粒细胞缺乏血液病患者并发嗜麦芽窄食单胞菌败血症的临床特征和预后分析

目的 探讨中性粒细胞缺乏血液病患者发生嗜麦芽窄食单胞菌败血症的临床特征和预后因素。方法 回顾性分析我科2006年1月—2016年12月收治的32例发生嗜麦芽窄食单胞菌败血症合并中性粒细胞缺乏患者的临床资料。结果 32例患者中急性白血病20例， 重型再生障碍性贫血 （SAA） 7例， 非霍奇金淋巴瘤5例。所有患者长时间应用广谱抗生素， 中心静脉置管 （21例） 或者外周静脉置管 （11例）。25例化疗后出现中性粒细胞缺乏， 7例SAA 为本病导致中性粒细胞缺乏。死亡17例， 好转15例。药敏试验显示多药耐药， 替加环素、 甲氧苄啶-磺胺甲噁唑、 左氧氟沙星、 头孢哌酮/舒巴坦、 头孢他啶、 哌拉西林/他唑巴坦部分敏感， 其余均耐药。重度中性粒细胞缺乏、 重度血小板减少、 粒细胞减少持续时间过长和复合感染等是预后不良因素。结论 中性粒细胞缺乏血液病患者并发嗜麦芽窄食单胞菌败血症死亡率高， 及时诊断和治疗对预后至关重要。

The characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia

Objective To investigate the characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia. Methods The clinical data of Stenotrophomonas maltophilia bacteremia in patients with neutropenia from January 2006 to December 2016 were respectively analyzed. Results In 32 patients with neutropenia, there were 20 cases with acute leukemia, 7 cases with severe aplastic anemian (SAA), and 5 cases of non-hodgkin lymphoma. All patients had long time to use broad-spectrum antibiotic history. Twenty-one patients had central venous catheters and eleven had peripheral venous catheters in situ. Twenty-five patients were found neutropenia due to chemotherapy, and seven cases with bone failure attributed to SAA. Seventeen patients were dead, and fifteen recovered. Drug susceptibility tests showed multiple drug resistance. Stenotrophomonas maltophilia were partially susceptive to tigercycline, trimethoprim - sulfamethoxazole, levofloxacin, cefoperazone-sulbactam. ceftazidime, minocycline and piperacillin-tazobactam. The severe neutropemia, thrombocytopenia, long duration of granulocyte reduction and polymicrobial infection were the adverse prognostic factors. Conclusion Stenotrophomonas maltophilia bacteremia in patients with neutropenia has a high mortality rate, which needs to timely diagnose and treatment with effective antibiotics.