摘要
目的:分析初发急性白血病患者在接受第1次诱导化学治疗(化疗)后,并发血流感染的临床特征、危险因素及病原菌株特点。方法:采用回顾性研究方法,对2013年10月至2015年2月在我科住院的258例初发急性白血病患者的临床资料进行统计分析。所有患者均接受标准诱导化疗,并给予常规护理。发热时均按照我国中性粒细胞缺乏(粒缺)伴发热患者抗菌药物临床应用指南行微生物检查及初始经验性抗菌药物治疗,根据微生物检查结果调整抗菌药物种类。统计分析其血流感染的临床特点及相关危险因素。结果:初发急性白血病患者接受诱导化疗后,合并血流感染者17例,发生率为6.58%。老年组(≥60岁)和非老年组(<60岁)血流感染发生率分别为18.6%和0.58%(P=0.013)。长时间粒缺组及短时间粒缺组血流感染发生率分别为9.38%和2.04%(P=0.021)。高白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)α、血β2微球蛋白均提示血流感染发生率高。病原体以革兰阴性菌为主,头孢3代耐药多见。粒缺持续时间、化疗前T细胞数量减少及血β2微球蛋白升高等是感染的危险因素。结论:急性白血病患者接受诱导化疗后合并血流感染发生率高。化疗后粒缺持续时间、化疗前T细胞数量减少及血β2微球蛋白升高是感染的危险因素,应采取积极的预防措施,根据血流感染病原特点经验性正确选择初始抗菌药物,可有效提高血流感染治疗效率。
Objectives To analyze the clinical characteristics and risk factors of blood stream infection and pathogenic bacteria after the first cycle of induction chemotherapy in acute leukemia patients. Methods A retrospective analysis of 258 patients with acute leukemia from October,2013 to February,2015 were performed. All the patients received standard induction chemotherapy and regular nursing. Every febrile patient was examined and treated with empirical antibiotic therapy under China guidelines for antibiotic treatment in febrile neutropenic patients. The antibiotics regimen was adjusted in accordance with the outcome of etiological pathogen test. A statistical analysis of clinical characteristics and related risk factors of blood stream infection was performed. Results The rate of blood stream infection complicated after induction therapy of acute leukemia was 6.58%. The blood stream infection rates of aged group（≥60） and nonaged group（60） were 18.6% and 0.58%,respectively（P=0.013）. The blood stream infection rates of long-term and shortterm neutropenic groups were 9.38% versus 2.04%,respectively（P=0.021）. High levels of interleukin（IL）-6,IL-8,tumor necrosis factor（TNF）-α,and serum β2-microglobulin indicated high occurrence rate of blood stream infections. Microorganisms documented were mainly G-bacillus and were frequently resistant to third generation cephalosporin. Conclusions The occurrence rate of blood stream infections after induction chemotherapy was high. Preventive measures should be undertaken in patients with independent risk factors,such as the persistance of post-chemotherapy neutropenia,the decrease of T cell count before chemotherapy and increasing level of serum β2-microglobulin. Optimal choice of empirical antibiotic therapy in accordance with the etiological pathogen characteristics of blood stream infection could improvethe efficacy of treatment and shorten the time for rebound of neutrophil count.
出处
《内科理论与实践》
2015年第5期359-363,共5页
Journal of Internal Medicine Concepts & Practice
基金
上海卫生系统先进适宜技术推广项目(项目编号:2013SY001)
关键词
急性白血病
血流感染
危险因素
诱导化疗
抗菌药物治疗
Acute leukemia
Blood stream infection
Risk factor
Induction chemotherapy
Antibiotic therapy
