血液病患者院内感染大肠埃希菌败血症临床分析

目的探讨血液病患者医院内感染大肠埃希菌败血症临床特点和防治措施。方法回顾性分析2006年6月至2011年6月住院血液病患者院内感染大肠埃希菌败血症的临床特点及感染途径。结果 5127例次住院血液病患者中,院内感染败血症107例次,大肠埃希菌占34.58%(37例次)。均在联合化疗、造血干细胞移植术或应用免疫抑制剂后中性粒细胞减少时发生,97%患者为粒细胞缺乏。81.1%的患者可找到原发感染部位,以肛周感染最为多见(35.1%)。经治疗后7例死亡,死亡率为18.9%,死亡原因为感染性休克、多器官功能衰竭。结论大肠埃希菌是血液病院内感染败血症的最常见病原体,病情严重,死亡率高,故应注意预防,化疗后尽快提高中性粒细胞计数,细菌培养及药敏未明确之前需要早期经验性治疗。

Clinical analysis on hospital infection of Escherichia coli induced hematosepsis in patients with hematopathy.

Objective To explore the clinical characteristics of E. coli induced hematosepsis in hospitalized patients with hematopathy. Methods The clinical characteristics of hospital infection of E. coli induced hematosepsis in patients with hematopathy treated from June 2006 to June 2011 were retrospectively analyzed. Results Of 5 127 hospitalized patients with hematopathy, 107 were found with hospital infection, of which 37 were infected with E. coli, accounting for 34.58%. All the patients were found with neutropenia after combined chemothepy, haemopoietic stem cell transplant or applicaiton of immunosuppressive agent. 97% of the patients were found with agranulocytosis. 81.12% of the patients can be found with primarily sites of infection, most of which were perianal infections (35.1%). Seven patients died after treatment, with a mortality of 17%. Septic shock and multiple organ failure were the main causes of death. Conclusion Escherichia coli is the most common pathogen of nosocomial hematosepsis for patients with hematopathy. Prophylaxis and quick elevation of neutrophil count are important for serious illness and high mortality. Early empirical treatment is critical before bacterial culture.