淋巴瘤患者化疗期间Ⅳ骨髓抑制期感染病原菌与相关因素分析
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摘要
目的探讨淋巴瘤患者化疗期间Ⅳ骨髓抑制期感染病原菌特点及相关因素。方法选择2015年1月-2018年1月于医院化疗的淋巴瘤患者Ⅳ骨髓抑制的患者513例为研究对象,分析感染患者的病原菌及耐药性、感染部位,并分析患者年龄、糖尿病史、住院时间等临床资料,归纳淋巴瘤患者化疗期间Ⅳ骨髓抑制期感染的相关因素。结果 513例淋巴瘤患者中感染53例,感染率为10.33%;以呼吸道感染和肛周感染及泌尿道感染为主;共培养分离病原菌63株,其中革兰阴性菌41株占65.08%,以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌19株占30.16%,以金黄色葡萄球菌和表皮葡萄球菌为主;真菌3株占4.76%。药敏结果显示,主要革兰阴性菌对庆大霉素、哌拉西林及头孢呋辛耐药率较高,而对美罗培南较敏感;金黄色葡萄球菌对利奈唑胺和万古霉素较敏感;年龄、住院时间及慢性心血管疾病史是淋巴瘤患者化疗期间Ⅳ骨髓抑制期感染的相关因素(P<0.001)。结论淋巴瘤患者化疗期间Ⅳ骨髓抑制期的感染因素较多,应针对感染相关因素采取相应措施,提高患者的生存质量。
OBJECTIVE To investigate the characteristics and related factors of pathogens in patients with lymphoma during Ⅳ myelosuppression stage.METHODS A total of 513 lymphoma patients at the stage of Ⅳ myelosuppression who were treated with chemotherapy in the hospital from Jan.2015 to Feb.2018 were selected as subjects.The pathogens,drug resistance and infection sites of infected patients were analyzed,and the clinical data such as age,diabetes history and length of hospital stay of the patients were analyzed.The factors associated with Ⅳ myelosuppressive infection during chemotherapy in patients with lymphoma were summarized.RESULTS Among the 513 patients with lymphoma,53 cases were infected,with an infection rate of 10.33%.The main infections were respiratory infection,perianal infection and urinary tract infection.A total of 63 strains of pathogens were isolated and cultured,of which 41 strains were gram-negative bacteria accounting for 65.08%,dominated by Escherichia coli and Klebsiella pneumoniae;19 strains were gram-positive bacteria accounting for 30.16%,dominated by Staphylococcus aureus and Staphylococcus epidermidis;and 3 strains were fungi accounting for 4.76%.Drug susceptibility results showed that the main Gram-negative bacteria had relatively high resistance rates to gentamicin,piperacillin and cefuroxime,but were more sensitive to meropenem.S.aureus was more sensitive to linezolid and vancomycin.Age,length of hospital stay,and history of chronic cardiovascular disease were related factors for Ⅳ myelosuppressive infection during chemotherapy in patients with lymphoma(P<0.001).CONCLUSION Patients with lymphoma have a number of infection factors in the Ⅳ myelosuppression stage during chemotherapy.Corresponding measures should be taken to improve the quality of life of patients.
OBJECTIVE To investigate the characteristics and related factors of pathogens in patients with lymphoma during Ⅳ myelosuppression stage.METHODS A total of 513 lymphoma patients at the stage of Ⅳ myelosuppression who were treated with chemotherapy in the hospital from Jan.2015 to Feb.2018 were selected as subjects.The pathogens,drug resistance and infection sites of infected patients were analyzed,and the clinical data such as age,diabetes history and length of hospital stay of the patients were analyzed.The factors associated with Ⅳ myelosuppressive infection during chemotherapy in patients with lymphoma were summarized.RESULTS Among the 513 patients with lymphoma,53 cases were infected,with an infection rate of 10.33%.The main infections were respiratory infection,perianal infection and urinary tract infection.A total of 63 strains of pathogens were isolated and cultured,of which 41 strains were gram-negative bacteria accounting for 65.08%,dominated by Escherichia coli and Klebsiella pneumoniae;19 strains were gram-positive bacteria accounting for 30.16%,dominated by Staphylococcus aureus and Staphylococcus epidermidis;and 3 strains were fungi accounting for 4.76%.Drug susceptibility results showed that the main Gram-negative bacteria had relatively high resistance rates to gentamicin,piperacillin and cefuroxime,but were more sensitive to meropenem.S.aureus was more sensitive to linezolid and vancomycin.Age,length of hospital stay,and history of chronic cardiovascular disease were related factors for Ⅳ myelosuppressive infection during chemotherapy in patients with lymphoma(P<0.001).CONCLUSION Patients with lymphoma have a number of infection factors in the Ⅳ myelosuppression stage during chemotherapy.Corresponding measures should be taken to improve the quality of life of patients.
引文
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[2]刘方,许燕.艾滋病合并淋巴瘤化疗的护理[J].世界最新医学信息文摘(连续型电子期刊),2015,(24):239-239.
[3]林动,黄雪珍,吴晖.恶性淋巴瘤化疗期间院内感染临床分析[J].福建医药杂志,2001,(6):29-31.
[4]Mostovoy Y,Demchuk A,Konstantynovych T,et al.From the persistent Epstein-Barr Virus infection to angioimmunobastic T-cell lymphoma-dramatic convergence.Anlysis of the clinical case[J].Georgian Med News,2018,(279):122-131.
[5]Fleming D,Stone J,Tansley P.Reply to the editor regarding:Magnusson MR,Deva AK Letter to the editor 2018 May 2 in relation to:Fleming D,Stone J,Tansley P.Spontaneous regression and resolution of breast implant-associated anaplastic large cell lymphoma:implications for research,diagnosis and clinical management.Aesth Plast Surg,2018[J].Aesthetic Plast Surg,2018,42(4):1167-1169.
[6]Tsai CY,Sun S,Zhang H,et al.APTO-253 is a new addition to the repertoire of drugs that can exploit DNABRCA1/2 deficiency[J].Mol Cancer Ther,2018,17(6):1167-1176.
[7]El-Cheikh J,Massoud R,Moukalled N,et al.Thiotepa 10mg/kg treatment regimen is superior to thiotepa 5mg/kg in TBF conditioning in patients undergoing allogeneic stem-cell transplantation[J].Clin Lymphoma Myeloma Leuk,2018,18(5):368-374.
[8]冯丽娜,冯莉霞.淋巴瘤化疗患者症状群的调查及相关因素分析[J].中国实用护理杂志,2017,33(27):2130-2133.
[9]Chabannon C,Larghero J.Considerations pertaining to cell collection and administration of industry-manufactured autologous CAR-T cells,in relation to French healthcare organization and regulations[J].Curr Res Transl Med,2018,66(2):59-61.
[10]薛永飞,李长生,任中海.非霍奇金淋巴瘤化疗患者肺部感染的病原学分析[J].中华医院感染学杂志,2014,24(9):2119-2121.
[11]陈喜林,仲凯励,杨怡欣,等.淋巴瘤化疗后并发间质性肺炎72例临床分析[J].军事医学,2012,36(3):213-216.
[12]苏建萍,马丽娟,朱娓,等.淋巴瘤化疗期病人正念水平影响因素的调查研究[J].护理研究,2018,(1):76-80.