热带地区恶性血液病患者血流感染特征及患者临床预后单中心分析

目的:研究热带地区恶性血液病患者血流感染的病原菌种类分布及耐药情况,分析患者预后及危险因素,为临床上血流感染的预防及治疗提供依据。方法:回顾性分析解放军总医院海南医院收治的恶性血液病患者血流感染的临床特征,血培养结果及预后。结果:本院81例次恶性血液病血流感染患者中原发感染部位以肺部(46.91%)最常见,其次为中心静脉置管(11.11%);血培养中革兰阳性菌及革兰阴性菌的检出率分别为60.98%和30.02%,其中凝固酶阴性葡萄球菌最多见;在革兰阴性菌中,排名前3位的分别是肺炎克雷伯菌(34.38%)、大肠埃希菌(18.75%)、铜绿假单胞菌(18.75%);革兰阳性菌对万古霉素利奈唑胺、替加环素等均100%敏感,革兰阴性菌对喹诺酮类药物耐药率较高,尤其是大肠埃希菌对喹诺酮类药物的耐药率高达83.33%;在总体生存方面,革兰阴性菌败血症患者的30d总生存率为77.42%,革兰阳性菌败血症患者30d的总生存率为92.00%,差异无统计学意义;多因素分析结果显示,感染性休克(P=0.001,RR=269.27)是恶性血液病患者血流感染死亡的独立危险因素,而疾病处于缓解状态(P=0.027,RR=0.114)是恶性血液病患者血流感染预后良好的独立保护因素。结论:与其他地区不同,革兰阳性菌是导致热带地区恶性血液病患者血流感染的主要病原菌;加强PICC导管护理是降低热带地区恶性血液病患者血流感染发生率的重要措施;使用正确的治疗方案使疾病达到缓解以及积极地预防和治疗感染性休克可以降低热带地区恶性血液病患者的死亡率。

Single Center Analysis of Bloodstream Infection Clinical Characteristics and Prognosis in Patients with Hematological Malignancies in the Tropics

Objective:To analyze the characteristics,prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics,so as to provide evidence for the prevention and treatment of bloodstream infection.Methods:The clinical features,blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied.Results:The most common primary infection site of the 81 patients with hematological malignancies was lung(46.91%),followed by PICC(11.11%).The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%,respectively.Coagulase-negative staphylococci was the most common Grampositive bacteria resulting in bloodstream infection in our study.Of the Gram-negatives,Klebsiella pneumoniae(34.38%)was predominant,followed by Escherichia coli(18.75%) and Pseudomonas aeruginosa(18.75%).Gram-positive bacteria was highly sensitive(100%) to vancomycin,linezolid and tigecycline.Study showed that Gram-negative bacteria had low sensitive to quinolones,in particular,the resistance rate of Escherichia coli to quinolones was as high as 83.33%.In terms of overall survival(OS),the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42%and 92.00%,respectively.There was no statistically significant difference between the two groups.Multivariate analysis revealed that septic shock(P=0.001,RR=269.27) was an independent risk factor for 30-day mortality,and remission status(P=0.027,RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies.Conclusion:Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics.Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics.A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.