恶性血液病并发医院产超广谱β-内酰胺酶阳性细菌感染的临床分析

目的 探讨恶性血液病并发医院产超广谱β-内酰胺酶（ESBLs）阳性细菌感染、危险因素及合并其他细菌混合感染和二重感染情况。方法 对1999年1月-2005年11月的恶性血液病患者,化疗后发生的46例医院ESBLs阳性细菌感染患者进行回顾性分析。结果 恶性血液病并发院内ESBLs阳性细菌感染主要是大肠埃希菌和肺炎克雷伯菌,以发生肺部感染最多,占67.4%,其次是败血症,占30.4%;主要危险因素是第三代头孢菌素的使用、化疗与肾上腺皮质激素使用、粒细胞缺乏;合并其他细菌混合感染发生率为41.3%,二重感染发生率为13.0%;对碳青酶烯类抗菌药物的敏感率为100.0%,对阿米卡星的敏感率为35.7%。结论 恶性血液病并发院内ESBLs阳性细菌感染患者预后差;选择合适的化疗强度、及时监测粒细胞水平、控制使用第三代头孢菌素、加强支持治疗是预防恶性血液病并发ESBLs阳性细菌感染的重要措施之一。

Nosocomial Infection by ESBLs Positive Bacteria after Chemotherapy in Malignant Hematopathy Patients: A Clinical Analysis

OBJECTIVE To investigate the nosocomial infection and risk factors of extended spectrum beta-lactamases (ESBLs),and the concomitant infection with other bacteria and double infection in patients of malignant hematopathy.METHODS Forty six malignant hematopathy patients with nosocomial infection by ESBLs positive bacteria were studied retrospectively.RESULTS ESBLs positive bacteria of nosocomial infection in patients of malignant hematopathy were Escherichia coli and Klebsiella.67.4% Were pulmonary infection and 30.4% with septicemia.Major risk factors were the usage of the third generation cephalosporin,the usage of chemotherapy and adrenal cortical hormone,and agranulocytosis.41.3% Cases had infection with other bacteria and 13.0% cases had double infection at the same time.All cases were sensitive to carbopenems,35.7% cases were sensitive to amikacin.CONCLUSIONS The prognosis of patients with nosocomial infection by ESBLs positive bacteria is bad.It is important to select appropriate chemotherapy,measure granulocyte amount in time,control the use of third generation cephalosporin and intensify support therapy.