Cheng Long-Can, Yang Ting, Kuang Hui-Hui, Yu Shuai, Guan Li-Xun, Gu Zhen-Yang, Xu Yuan-Yuan, Zheng Wen-Shuai, Wang Lu, Hu Ya-Lei, Gao Xiao-Ning, Wang Quan-Shun
Department of Hematology, Hainan Hospital of PLA General Hospital Sanya 572000, Hainan Province, China.
Department of Clinical Laboratorial Examination, Hainan Hospital of PLA General Hospital, Sanya 572000, Hainan Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Feb;29(1):265-271. doi: 10.19746/j.cnki.issn.1009-2137.2021.01.044.
To analyze the characteristics, prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics, so as to provide evidence for the prevention and treatment of bloodstream infection.
The clinical features, blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied.
The most common primary infection site of the 81 patients with hematological malignancies was lung (46.91%), followed by PICC (11.11%). The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%, respectively. Coagulase-negative staphylococci was the most common Gram-positive bacteria resulting in bloodstream infection in our study. Of the Gram-negatives, Klebsiella pneumoniae (34.38%) was predominant, followed by Escherichia coli (18.75%) and Pseudomonas aeruginosa (18.75%). Gram-positive bacteria was highly sensitive (100%) to vancomycin, linezolid and tigecycline. Study showed that Gram-negative bacteria had low sensitive to quinolones, in particular, the resistance rate of Escherichia coli to quinolones was as high as 83.33%. In terms of overall survival (OS), the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42% and 92.00%, respectively. There was no statistically significant difference between the two groups. Multivariate analysis revealed that septic shock (P=0.001, RR=269.27) was an independent risk factor for 30-day mortality, and remission status (P=0.027, RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies.
Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics. Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics. A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.
分析热带地区血液系统恶性肿瘤患者血流感染的特点、预后及危险因素，为血流感染的防治提供依据。
回顾性研究解放军总医院海南医院收治的血液系统恶性肿瘤合并血流感染患者的临床特征、血培养结果及预后。
81例血液系统恶性肿瘤患者最常见的原发感染部位为肺部（46.91%），其次为经外周静脉穿刺中心静脉置管（PICC）（11.11%）。血培养中革兰阳性菌和革兰阴性菌的检出率分别为60.98%和30.02%。凝固酶阴性葡萄球菌是本研究中导致血流感染最常见的革兰阳性菌。革兰阴性菌中，肺炎克雷伯菌（34.38%）占主导，其次为大肠埃希菌（18.75%）和铜绿假单胞菌（18.75%）。革兰阳性菌对万古霉素、利奈唑胺和替加环素高度敏感（100%）。研究表明革兰阴性菌对喹诺酮类药物敏感性低，尤其是大肠埃希菌对喹诺酮类药物的耐药率高达83.33%。在总生存（OS）方面，革兰阴性菌和革兰阳性菌败血症患者的30天OS分别为77.42%和92.00%。两组间差异无统计学意义。多因素分析显示，感染性休克（P=0.001，RR=269.27）是30天死亡率的独立危险因素，缓解状态（P=0.027，RR=0.114）是血液系统恶性肿瘤患者血流感染良好转归的独立预测因素。
革兰阳性菌是热带地区血液系统恶性肿瘤患者血流感染主要病原菌。加强PICC护理是降低热带地区血液系统恶性肿瘤患者血流感染发生率的重要措施。正确的疾病缓解治疗及有效的感染性休克防治可降低热带地区血液系统恶性肿瘤血流感染患者死亡率。
