1993-2004年血液病房2388例次住院患者感染分析

目的探讨血液病房医院、社区感染的发生、转归情况。方法回顾性分析了北京协和医院血液科1993-2004年2388例次住院患者发生细菌和真菌感染的情况。结果全部住院患者中，819例次（34．3％）发生感染，其中社区感染为237例次（9．9％），医院感染为582例次（24．4％）。在医院感染中，以革兰阴性菌为主，痰培养常见病原菌为铜绿假单胞菌（18株，16％），血培养主要为大肠埃希菌（36株，43％），一些耐药的革兰阳性菌也较常见，如痰中肠球菌属（30株，27％）、凝固酶阴性的葡萄球菌（13株，12％）；在社区感染中，痰中以副流感杆菌（9株，15％）、凝固酶阴性的葡萄球菌（9株，15％）为主；血中以凝固酶阴性的葡萄球菌（9株，28％）、大肠埃希菌（9株，28％）为主。医院感染真菌较社区感染更为常见，主要以念珠菌为主。12年中，医院感染痰中始终以铜绿假单胞菌为主，而血培养中，大肠埃希菌、阴沟肠杆菌比例逐年增加；社区感染痰中的金黄色葡萄球菌，血中的克雷伯菌属比例逐年增加。所有部位的真菌感染的比例亦逐年增加。医院感染死亡36例（6．1％），社区感染死亡9例（3．8％，P=0．17）。社区感染死亡率近年呈逐渐减少趋势，而医院感染死亡率变化不大。结论血液科患者感染发生率高，医院感染比例数值高于社区感染，死亡率较高，且以革兰阴性菌为主，耐药菌多，真菌感染比例高，并有逐年加重的倾向。

Infection pathogen analysis of 2388 patients in an open hematology ward from 1993 to 2004

Objective To investigate the incidence of infection and pathogens in hematology ward. Methods The data of incidence, pathogen, and outcome of infection of 2388 inhospitalized patients in an open haematology ward of Peking Union Medical College Hospital from 1993 to 2004 were analyzed retrospectively. Results The overall incidence of infection was 34.3% according to the person-times of hospitalization, 24.4% for nosocomial infection and 9.9% for community-acquired infection. Most of the pathogenic bacteria of the nosocomial infection were Gram negative. The most common bacteria in the sputum samples included Enterobacter (27%), Pseudomonas aeruginosa (16%) and coagulase negative Staphylococcus (MRSCoN, 12%), the most common bacteria in the blood samples included Escherichia coli(43%), Enterobacter cloacae (11%), and Klebsiella (11%). Whereas in the community-acquired infection the most common bacteria in the sputum samples were Haemophilus parainfluenzae (15%), MRSCoN (28%), and Staphylococcus epidermidis (10%), and the most common bacteria in the blood samples were MRSCoN (28%), E. coli (28%), and Klebsiella (9.4%). Fungi were more often found in nosocomial infection, especially in the sputum samples. 12-year follow up showed that in nosocomial infection Pseudomonas aeruginosa remained the most common bacteria in the sputum samples, whereas E. coli and Enterobacter cloacae became the major bacteria in the blood samples. In community-acquired infection, the proportion of Staphylococcus aureus, that of Klebsiella in blood samples, and that of E. coli in throat swab samples increased in recent years. The incidence of fungi infection had increased in both nosocomial infection and community acquired infection. The mortality of nosocomial infection was 6.1%, higher than that of the community-acquired infection, however, not statistically significant (P=0.17). There was a trend of decrease in the mortality of community-acquired infection but did not in the nosocomial infection. Conclusion The patients in hematology ward are susceptible to infection, especially nosocomial infection that has a higher mortality rate in comparison with the community-acquired infection, however, not statistically significant. The pathogens of nosocomial infection are most likely G- bacteria, fungi and other bacteria resistant to most antibiotics. The mortality rate of nosocomial infection remains almost unchanged in the 12-year follow up.