Feng Dan, Zhang Yong-Tian, Qiu Ting-Ting, Xu Kai-Lin
Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002，Jiangsu Province, China.
Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002，Jiangsu Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Apr;28(2):602-608. doi: 10.19746/j.cnki.issn.1009-2137.2020.02.041.
To analyze the clinical characteristics of infection within 100 days after hematopoietic stem cell transplantation (HSCT) in patients with hematologic disease.
The culture results of 313 HSCT patients infected in the hematology department of our hospital from January 2013 to January 2019 were collected, and the infection incidence, pathogen distribution, drug susceptibility test results and infection risk factors out of them all were analyzed.
Among 313 HSCT patients, infection occurred within 100 days in 262(83.7%) patients, 234 (89.3%) cases were in neutropenic period at infection onset. 156 pathogen distributions showed that the bloodstream infection (64.1%) ranked first. Among isolates, Gram-negative bacteria was 86 (55.1%), which were higher than Gram-positive bacteria (49, 31.4%), and fungi was 21(13.5%). The prevalence of ESBLs in E.coli and Klebsiella pneumoniae were 36.4% and 31.6%, respectively. The drug resistance rates of E.coli and Klebsiella pneumoniae to carbapenems were 18.20% and 5.3%, respectively, and to amikacin were 29.5% and 10.5%, respectively. The antimicrobial resistance of fermentation bacteria was significantly different. The drug resistence rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems were high. Only one strain of methicillin-resistant staphylococcus aureus (MRSA) was found. The drug resistence rates of enterococcus faecalis to linezolid was 14.30%. The sensitivity of other Gram-positive bacteria to vancomycin, teicolanin and linezolid was 100%. The HSCT in our hospital was mainly allogeneic, and univariate analysis showed that the risk factors for infection were status before trasplantion, HLA matching type,length of stay for the first transplant, and length of neutropenia, while Mulvariate analysis showed that only HLA matching type showed statistical significance.
The infection of patients after HSCT occurrs in period of neutropenia, Most of pathogens are G bacteria, and the resistance to antibiotics is quite common, HLA mismatch is allo-HSCT independent risk factors for infection. It is very imprtant to monitor actively the distribution of pathogenic bacteria, drug-resistance and risk factors of infection for guiding more reasonable and standardized clinical treatment.
分析血液病患者造血干细胞移植（HSCT）后100天内感染的临床特征。
收集2013年1月至2019年1月在我院血液科进行HSCT的313例感染患者的培养结果，分析其感染发生率、病原体分布、药敏试验结果及感染危险因素。
313例HSCT患者中，262例（83.7%）在100天内发生感染，234例（89.3%）感染发生在中性粒细胞缺乏期。156例病原体分布显示，血流感染（64.1%）位居首位。分离菌株中，革兰阴性菌86株（55.1%），高于革兰阳性菌（49株，31.4%），真菌21株（13.5%）。大肠埃希菌和肺炎克雷伯菌中ESBLs的检出率分别为36.4%和31.6%。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类的耐药率分别为18.20%和5.3%，对阿米卡星的耐药率分别为29.5%和10.5%。发酵菌的耐药情况差异显著。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类的耐药率较高。仅发现1株耐甲氧西林金黄色葡萄球菌（MRSA）。粪肠球菌对利奈唑胺的耐药率为14.30%。其他革兰阳性菌对万古霉素、替考拉宁和利奈唑胺的敏感性为100%。我院HSCT主要为异基因移植，单因素分析显示，感染的危险因素为移植前状态、HLA配型类型、首次移植住院时间和中性粒细胞缺乏持续时间，而多因素分析显示，仅HLA配型类型具有统计学意义。
HSCT患者感染多发生在中性粒细胞缺乏期，病原体以革兰阴性菌为主，对抗生素耐药情况较为普遍，HLA配型不合是异基因HSCT感染的独立危险因素。积极监测病原菌分布、耐药情况及感染危险因素，对于指导临床更合理、规范治疗具有重要意义。
