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血液系统恶性肿瘤患者细菌性血流感染的流行病学与死亡率

Epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies.

作者信息

Mert Duygu, Ceken Sabahat, Iskender Gulsen, Iskender Dicle, Merdin Alparslan, Duygu Fazilet, Ertek Mustafa, Altuntas Fevzi

机构信息

University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Infectious Diseases and Clinic Microbiology Clinic, Ankara, Turkey.

University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Hematology Clinic and Bone Marrow Transplantation Unit, Ankara, Turkey.

出版信息

J Infect Dev Ctries. 2019 Aug 31;13(8):727-735. doi: 10.3855/jidc.11457.

Abstract

INTRODUCTION

Patients with hematological malignancies, who are in the high risk group for infectious complications and bacterial bloodstream infections. The aim of the study evaluated epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies. In addition to determine the risk factors, changes in the distribution and frequency of isolated bacterias.

METHODOLOGY

In this retrospective study. There were investigated data from 266 patients with hematological malignancies and bacterial bloodstream infections who were hospitalized between the dates 01/01/2012 and 12/31/2017.

RESULTS

There were 305 blood and catheter cultures in febrile neutropenia attacks in total. In these total attacks, primary bloodstream infections were 166 and catheter-related bloodstream infections were 139. In blood cultures; Escherichia coli and Klebsiella pneumoniae bacteria were detected in 58,0% and 22,9% of the samples, respectively. 52,4% of the cultured Gram-negative bacterias were extended spectrum beta-lactamase (ESBL). Carbapenemase positive culture rate was 17,2% in Gram-negative bacteria cultures. Staphylococcus epidermidis was found in 38,4% of the Gram-positive bacteria cultures. In Gram-positive bacteria; methicillin resistance were detected in 82,2% of the samples. There was a statistically significant relationship between bloodstream infection and disease status. 60 patients with primary bloodstream infections were newly diagnosed.

CONCLUSIONS

In patients with hematological malignancies, certain factors in the bloodstream infections increase the mortality rate. With the correction of these factors, the mortality rate in these patients can be reduced. The classification of such risk factors may be an important strategy to improve clinical decision making in high-risk patients, such as patients with hematological malignancies.

摘要

引言

血液系统恶性肿瘤患者是感染并发症和细菌性血流感染的高危人群。本研究旨在评估血液系统恶性肿瘤患者细菌性血流感染的流行病学和死亡率。此外,还确定了危险因素、分离细菌的分布和频率变化。

方法

在这项回顾性研究中,调查了2012年1月1日至2017年12月31日期间住院的266例血液系统恶性肿瘤合并细菌性血流感染患者的数据。

结果

发热性中性粒细胞减少发作期间共进行了305次血液和导管培养。在这些发作中,原发性血流感染166例,导管相关血流感染139例。血液培养中,分别在58.0%和22.9%的样本中检测到大肠杆菌和肺炎克雷伯菌。52.4%的培养革兰氏阴性菌为超广谱β-内酰胺酶(ESBL)。革兰氏阴性菌培养中碳青霉烯酶阳性培养率为17.2%。表皮葡萄球菌在38.4%的革兰氏阳性菌培养中被发现。在革兰氏阳性菌中,82.2%的样本检测到耐甲氧西林。血流感染与疾病状态之间存在统计学显著关系。60例原发性血流感染患者为新诊断病例。

结论

在血液系统恶性肿瘤患者中,血流感染的某些因素会增加死亡率。纠正这些因素后,这些患者的死亡率可以降低。对这类危险因素进行分类可能是改善高危患者(如血液系统恶性肿瘤患者)临床决策的重要策略。

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