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淋巴组织肿瘤患者合并血流细菌感染的临床及细菌学分析

[Clinical and bacteriological analysis of lymphoid tissue neoplasms patients with bacteria bloodstream infections].

作者信息

Wang T Y, Li Z J, Lin Q S, Su D, Lyu R, Deng S H, Sui W W, Fu M W, Huang W Y, Liu W, Liu H, Qiu L G

机构信息

State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2017 Dec 14;38(12):1043-1048. doi: 10.3760/cma.j.issn.0253-2727.2017.12.007.

Abstract

To investigate the clinical status of lymphoid tissue neoplasms patients with bacteria bloodstream infections, bacteriology and drug susceptibility results, and provide the basis for rational clinical anti-infection option. A retrospectively analysis of clinical data and bacterial susceptibility test results of patients with bacteria bloodstream infections from September 2010 to December 2014 was conducted. A total of 134 cases including 107 patients with bloodstream infections were enrolled. 84 cases were male, 50 cases were female, the median age was 31 (12-71) years old. 112 cases were agranulocytosis, and 106 cases were severe agranulocytosis (ANC<0.1×10(9)/L) . 27 cases underwent hematopoietic stem cell transplantation, 100 cases received chemotherapy[33 cases with VD (I) CP±L (vincristine+daunorubicin/idarubicin + cyclophosphamide + prednison±asparaginasum) induction chemotherapy, 41 cases with intensive chemotherapy of Hyper-CVAD/MA or MA (mitoxantrone+cytarabine) , 26 cases with other chemotherapy regimens], and 7 cases were infected without chemotherapy. 10 patients discharged from hospital owing to treatment abandoning, 120 cases were cured through anti-infective therapy, 2 patients died of bacteria bloodstream infections, 1 patient died of sudden cardiac, and 1 patient died of GVHD after allogenic hematopoietic stem cell transplantation. A total of 144 strains were isolated, including 108 strains (75.0%) of Gram-negative bacteria and 36 strains (25.0%) of Gram-positive cocci. The susceptibility of Gram-negative bacteria to the carbapenems was 98.00%, and the adjustment treatment rate of carbapenems was 3.0%. The susceptibility of Gram-negative bacteria to the other antibiotics was 60.30%, and the adjustment treatment rate was 90.5%. The susceptibility of Grampositive cocci to the carbapenems was 49.3%, and to glycopeptides and linezolid was 100.0%. Comparing all patients'empirical use of antimicrobial agents with the drugs susceptibility results of blood cultures, 80.1% of the patients'initial drug selection was sensitive. The lymphoid neoplasms patients experienced bacteria bloodstream infections most often after receiving the chemotherapy regimens of treating acute lymphoblastic leukemia. The majority type of bacteria was Gram-negative bacteria. Drug susceptibility test showed that susceptibility of Gram-negative bacteria to the carbapenems was the highest, and the treatment adjustment rate was obviously lower. The susceptibility of Gram-positive cocci to glycopeptides and linezolid was high, and which could be applied to the patients with Gram-positive cocci sepsis on basis of susceptibility results in general.

摘要

探讨淋巴组织肿瘤患者合并细菌血流感染的临床状况、细菌学及药敏结果,为临床合理选择抗感染药物提供依据。对2010年9月至2014年12月期间合并细菌血流感染患者的临床资料及细菌药敏试验结果进行回顾性分析。共纳入134例患者,其中107例发生血流感染。男性84例,女性50例,年龄中位数为31(12 - 71)岁。112例患者存在粒细胞缺乏,106例为严重粒细胞缺乏(中性粒细胞绝对值<0.1×10⁹/L)。27例患者接受了造血干细胞移植,100例接受了化疗[33例采用VD(I)CP±L(长春新碱 + 柔红霉素/伊达比星 + 环磷酰胺 + 泼尼松±门冬酰胺酶)诱导化疗,41例采用Hyper - CVAD/MA或MA(米托蒽醌 + 阿糖胞苷)强化疗,26例采用其他化疗方案],7例未接受化疗而发生感染。10例患者因放弃治疗出院,120例经抗感染治疗治愈,2例死于细菌血流感染,1例死于心源性猝死,1例在异基因造血干细胞移植后死于移植物抗宿主病。共分离出144株病原菌,其中革兰阴性菌108株(75.0%),革兰阳性球菌36株(25.0%)。革兰阴性菌对碳青霉烯类药物的敏感率为98.00%,碳青霉烯类药物调整治疗率为3.0%。革兰阴性菌对其他抗生素的敏感率为60.30%,调整治疗率为90.5%。革兰阳性球菌对碳青霉烯类药物的敏感率为49.3%,对糖肽类和利奈唑胺的敏感率为100.0%。将所有患者抗菌药物的经验性使用与血培养药敏结果进行比较,80.1%的患者初始用药选择敏感。淋巴组织肿瘤患者在接受急性淋巴细胞白血病化疗方案后最常发生细菌血流感染。病原菌以革兰阴性菌为主。药敏试验显示,革兰阴性菌对碳青霉烯类药物的敏感率最高,治疗调整率明显较低。革兰阳性球菌对糖肽类和利奈唑胺的敏感率较高,一般可根据药敏结果应用于革兰阳性球菌败血症患者。

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