Ding L M, Song X L, Wang X G, Peng Y, Chen Y R, Jin L, Lan J P
Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu 233030, China.
Department of Hematology and Hematopoietic Stem Cell Transplant Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China.
Zhonghua Xue Ye Xue Za Zhi. 2021 Oct 14;42(10):807-813. doi: 10.3760/cma.j.issn.0253-2727.2021.10.003.
To elucidate the clinical characteristics of bloodstream infection in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in our hospital and improves the survival of transplant patients with bloodstream infection. Two hundred and ten patients with allo-HSCT from the Department of Hematology were retrospectively analyzed between October 2014 and September 2019. Pathogen distribution, drug resistance, risk factors, and outcomes were investigated in 49 allo-HSCT patients with bloodstream infections. Forty-nine of 210 patients with allo-HSCT had bloodstream infection, and 59 pathogenic microorganisms were identified, mainly Gram-negative bacteria (67.8%) , of which E. coli had the highest incidence (23.7%) , CRO accounted for 42.5%, and Grampositive bacteria accounted for 23.7% (without vancomycin or linezolid-resistant strain) . Additionally, fungi accounted for 8.5%. Univariate analysis suggested that the risk factors of bloodstream infection were gender, pretransplant disease status, and conditioning regimen. In contrast, multivariate analysis showed that bloodstream infection was mainly related to conditioning regimens. Further grouping results showed that 77.6% of patients with neutropenia had bloodstream infections, and 22.4% of patients with non-neutropenia had bloodstream infections; 81.0% of patients with active infections before transplantation had bloodstream infections, while bloodstream infection occurred in 16.9% of patients without active infection. Survival analysis showed that long-term survival of patients with bloodstream infection is shorter than that of patients without bloodstream infection and long-term survival of patients with CRO infection is shorter than that of patients without CRO infection. The survival of patients with neutropenia longer than 14 d is shorter than that of patients with neutropenia shorter than 14 d. Furthermore, there is no correlation between whether there is an active infection before transplantation and whether they are in a neutropenic state at the time of infection and survival. Our results suggest that effective prevention of bloodstream infections from drug-resistant bacteria, particularly CRO, shortening the duration of neutropenia, eradication of potential infections before transplantation, and patient-adaptive conditioning could reduce transplant-related mortality and improve prognosis.
为阐明我院异基因造血干细胞移植（allo-HSCT）患者血流感染的临床特征并提高血流感染移植患者的生存率。回顾性分析2014年10月至2019年9月间血液科210例allo-HSCT患者。对49例发生血流感染的allo-HSCT患者的病原体分布、耐药性、危险因素及转归进行调查。210例allo-HSCT患者中有49例发生血流感染，共鉴定出59株致病微生物，以革兰阴性菌为主（67.8%），其中大肠埃希菌发病率最高（23.7%），耐碳青霉烯类（CRO）占42.5%，革兰阳性菌占23.7%（无万古霉素或利奈唑胺耐药菌株）。此外，真菌占8.5%。单因素分析提示血流感染的危险因素为性别、移植前疾病状态及预处理方案。相比之下，多因素分析显示血流感染主要与预处理方案有关。进一步分组结果显示，中性粒细胞减少患者血流感染发生率为77.6%，非中性粒细胞减少患者血流感染发生率为22.4%；移植前有活动性感染患者血流感染发生率为81.0%，无活动性感染患者血流感染发生率为16.9%。生存分析显示，血流感染患者的长期生存率低于无血流感染患者，CRO感染患者的长期生存率低于无CRO感染患者。中性粒细胞减少超过14天患者的生存率低于中性粒细胞减少短于14天的患者。此外，移植前是否有活动性感染与感染时是否处于中性粒细胞减少状态及生存率之间无相关性。我们的结果表明，有效预防耐药菌尤其是CRO引起的血流感染、缩短中性粒细胞减少持续时间、根除移植前潜在感染以及采用适合患者的预处理方案可降低移植相关死亡率并改善预后。
