Zhu G Q, Xu C H, Lin Q S, Wang X X, Wang L L, Zhao N N, Feng S Z, Chen Y M
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Aug 14;41(8):655-660. doi: 10.3760/cma.j.issn.0253-2727.2020.08.007.
To investigate the microbiologic and clinical characteristics of bloodstream infection in neutropenic pediatric patients with hematological malignancies and provide data support for the rational use of antimicrobial agents in these patients. A retrospective analysis was performed on the clinical data, pathogen species distribution, and drug sensitivity data of bloodstream infection in neutropenic pediatric patients with hematological malignancies from the Institute of Hematology & Blood Diseases Hospital from January 2014 to December 2018. Total 537 episodes of bloodstream infections occurred in 427 neutropenic children with hematological malignancies; the 30-day all-cause mortality rate was 3.7%. The clinical feature of 44.7% patients with bloodstream infection was only fever, and the pathogenic bacteria were mainly enterobacteriaceae bacteria. Bloodstream infection was usually accompanied by oral mucosa (20.7%) , respiratory tract (20.5%) , and digestive tract (14.3%) symptoms. The distribution of pathogens in patients with different symptoms of bloodstream infection varied ((2)=40.561, =0.001) . Total 550 strains of pathogens were isolated, and the top 5 bacteria were Streptococcus aureus (109 strains, 19.8%) , Escherichia coli (99 strains, 18.0%) , Staphylococcus epidermidis (75 strains, 13.6%) , Klebsiella pneumoniae (67 strains, 12.2%) , and Staphylococcus aureus (32 strains, 5.8%) . The resistance rates of Enterobacteriaceae and Pseudomonas aeruginosa to piperacillin/tazobactam and carbapenems were <5%. The proportion of methicillin-resistant Staphylococcus aureus (MRSA) in Staphylococcus aureus was 9.7%. The proportion of pathogenic bacteria gram-positive cocci and gram-negative bacilli in the bloodstream infection of neutropenic children with hematological malignancies was approximately the same, suggesting that the use of antimicrobial agents should be broad-spectrum. Carbapenems, glycopeptides, and enzyme inhibitor complexes still have good effects.
探讨血液系统恶性肿瘤中性粒细胞减少的儿科患者血流感染的微生物学及临床特征，为这些患者合理使用抗菌药物提供数据支持。对2014年1月至2018年12月期间血液病医院血液系统恶性肿瘤中性粒细胞减少的儿科患者血流感染的临床资料、病原菌种类分布及药敏数据进行回顾性分析。427例血液系统恶性肿瘤中性粒细胞减少的儿童共发生537次血流感染；30天全因死亡率为3.7%。44.7%的血流感染患者临床特征仅为发热，病原菌主要为肠杆菌科细菌。血流感染常伴有口腔黏膜（20.7%）、呼吸道（20.5%）和消化道（14.3%）症状。不同血流感染症状患者的病原菌分布存在差异（χ²=40.561，P=0.001）。共分离出550株病原菌，前5位细菌依次为金黄色葡萄球菌（109株，19.8%）、大肠埃希菌（99株，18.0%）、表皮葡萄球菌（75株，13.6%）、肺炎克雷伯菌（67株，12.2%）和金黄色葡萄球菌（32株，5.8%）。肠杆菌科细菌和铜绿假单胞菌对哌拉西林/他唑巴坦和碳青霉烯类的耐药率<5%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的比例为9.7%。血液系统恶性肿瘤中性粒细胞减少的儿科患者血流感染中病原菌革兰阳性球菌和革兰阴性杆菌的比例大致相同，提示抗菌药物应使用广谱的。碳青霉烯类、糖肽类和酶抑制剂复合制剂仍有良好疗效。
