成人急性髓系白血病患者化疗后发生院内感染影响因素及其防治对策研究
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摘要
目的:探讨成人急性髓系白血病患者化疗后发生院内感染的影响因素及其防治对策。方法:回顾性分析2014年6月至2017年6月在本院就诊的109例成人急性髓系白血病患者化疗后感染的临床资料,回归分析患者临床因素,探究患者化疗后感染的影响因素。结果:109例患者接受化疗共267例次,发生感染168例次,医院感染率为62.92%,其主要发病部位包括上呼吸道感染和肺部感染等。168例次感染中有155例次采集标本并送实验室培养,获得病原菌32株,阳性率为20.6%(32/155),其中包括革兰氏阴性菌14株、革兰氏阳性菌9株、真菌4株及其他病原菌5株。统计发现,年龄超过40岁、春夏季住院、接受糖皮质激素治疗、高化疗强度、中性粒细胞数目、白细胞数目及血红蛋白含量是急性髓系白血病患者化疗后感染的独立危险因素(P<0.05)。结论:年龄超过40岁、春夏季住院、接受糖皮质激素治疗、高化疗强度、白细胞计数、中性粒细胞计数及血红蛋白含量是急性髓系白血病患者化疗后发生感染的独立危险因素;对有上述特征的患者应严密监视,做好预防工作必要时控制患者化疗强度,积极控制感染的发生,一旦发生感染,需及时强有力的抗感染治疗。
Objective: To investigate the influencing factors of nosocomial infection in adult patients with acute myeloid leukemia( AML) and its control strategies. Methods: The clinical data of 109 patients with AML treated in our hospital from June 2014 to June 2017 were retrospectively analyzed. The clinical factors were analyzed retrospectively,and the influencing factors of infection after chemotherapy were explored. Results: A total of 109 patients received chemotherapy for 267 case-times, the infection occurred in 168 case-times, the nosocomial infection rate was 62. 92%,the main affected sites included upper respiratory tract and lung. 155 samples from 168 case-times infection patients were collected and cultured, 32 pathogens were obtained with a positive rate 20. 6%( 32/155),including 14 Gram-negative bacteria, 9 Gram-positive bacteria and 4 strains of fungi and 5 strains of other pathogens. Statistics showed that the patient's age over 40 years old, hospitalization in spring and summer, glucocorticoid therapy, high intensity chemotherapy, neutrophil count, white blood cell count and hemoglobin content were the independent risk factors for infection after chemotherapy in AML patients( P <0. 05). Conclusion: The age of more than 40 years old,hospitalization in spring and summer, gluocorticoid therapy, high-intensity chemotherapy, white blood cell count,neutrophil count and hemoglobin content are the independent risk factors for infection after chemotherapy in the AML patients with the above-mentioned characteristics, they should be closely monitored, and chemotherapy intensity should be controled, so as to control the occurrence of infection; and in the event of infection, a timely powerful anti-infective treatment would be indispensable.
Objective: To investigate the influencing factors of nosocomial infection in adult patients with acute myeloid leukemia( AML) and its control strategies. Methods: The clinical data of 109 patients with AML treated in our hospital from June 2014 to June 2017 were retrospectively analyzed. The clinical factors were analyzed retrospectively,and the influencing factors of infection after chemotherapy were explored. Results: A total of 109 patients received chemotherapy for 267 case-times, the infection occurred in 168 case-times, the nosocomial infection rate was 62. 92%,the main affected sites included upper respiratory tract and lung. 155 samples from 168 case-times infection patients were collected and cultured, 32 pathogens were obtained with a positive rate 20. 6%( 32/155),including 14 Gram-negative bacteria, 9 Gram-positive bacteria and 4 strains of fungi and 5 strains of other pathogens. Statistics showed that the patient's age over 40 years old, hospitalization in spring and summer, glucocorticoid therapy, high intensity chemotherapy, neutrophil count, white blood cell count and hemoglobin content were the independent risk factors for infection after chemotherapy in AML patients( P <0. 05). Conclusion: The age of more than 40 years old,hospitalization in spring and summer, gluocorticoid therapy, high-intensity chemotherapy, white blood cell count,neutrophil count and hemoglobin content are the independent risk factors for infection after chemotherapy in the AML patients with the above-mentioned characteristics, they should be closely monitored, and chemotherapy intensity should be controled, so as to control the occurrence of infection; and in the event of infection, a timely powerful anti-infective treatment would be indispensable.
引文
1尚晋,魏天南,陈为民,等.急性白血病化疗后医院感染危险因素分析.中国感染与化疗杂志,2012;12(4):276-279.
2 白艳玲,李武平,刘冰,等.206例急性白血病化疗患者医院感染危险因素分析及护理对策.护理学报,2012;19(3):71-73.
3 黄先豹,卢玮,纪德香,等.急性白血病患者化疗后医院感染危险因素分析.中华医院感染学杂志,2014;24(7):1702-1704.
4 Bay C,González T,Munoz G,et al.Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia.Rev Chilena Infectol,2017;34(3):280-286.
5 Ohyama N,Torio M,Nakashima K,et al.A childhood-onset intestinal toxemia botulism during chemotherapy for relapsed acute?leukemia.Ann Clin Microbiol Antimicrob,2017;16(1):61.
6 孔兴美,周丽丽,叶蓉,等.急性白血病患者化疗后医院感染危险因素分析及护理.国际护理学杂志,2016;35(1):135-137.
7 Bay C,González T,Munoz G,et al.Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia.Rev Chilena Infectol,2017;34(3):280-286.
8 杨荣,朱易萍,马志贵,等.儿童急性白血病化疗后院内感染危险因素分析.国际输血及血液学杂志,2013;36(5):395-397.
9 Sanna M,Caocci G,La Nasa G.How we manage invasive fungal disease in acute myeloid leukemia patients with glucose 6 dehydrogenase deficiency.Mediterr J Hematol Infect Dis,2017;9(1):2017-2027.
10 董洪婧,彭庆峰,张奎,等.急性白血病患者医院感染的危险因素分析.中华医院感染学杂志,2016;26(16):3724-3726.
11 Shah K,Curtin BF,Flasar MH,et al.Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia.World J Clin Oncol,2017;8(5):398-404.
12 魏沄沄,张元元,甄英姿,等.儿童急性淋巴细胞白血病诱导化疗期导管相关性血栓发病及危险因素分析.中华血液学杂志,2017;38(4):313-317.
13 Ben Khelil M,Chkirbene Y,Mlika M,et al.Unexpected infant death secondary to a pulmonary infiltration due to acute myelocytic leukaemia.Malays J Pathol,2017;39(2):193-196.
14 周文锦,俞康,郑翠苹,等.白血病患者血流感染危险因素分析.中华医院感染学杂志,2013;23(22):5421-5422,5425.
15 Gharavi MJ,Roozbehani M,Mandeh Z.Detection of anti-Toxoplasma gondii antibodies in chronic myeloid leukemia and acute myeloid leukemia patients.Vet World,2017;10(9):1063-1065.
16 郎香花,黄健,章敏,等.急性白血病化疗患者血流感染的医源性危险因素分析.中华医院感染学杂志,2015;25(20):4696-4698.
17 Lucas N,Humble M,Sim D,et al.Temporal changes in neutropenic blood culture isolates and disease associations:a single centre series of 1139 episodes.Intern Med J,2017;47(8):962-965.
18 丁蓉芳,孙树梅.急性白血病患儿医院感染病原菌及危险因素分析.中国感染控制杂志,2015;14(5):325-328.
19 Tripathy K,Mittal K,Venkatesh P,et al.Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir.Oman J Ophthalmol,2017;10(3):250-252.
20 陈艳梅,孙卫东,代萍,等.老年急性白血病医院感染特点及危险因素分析.西部医学,2015;27(9):1340-1343.
21 Sakamoto K,Tomoyasu C,Yano M,et al.Monitoring of minimal residual disease after HLA-mismatched allogeneic hematopoietic stem cell transplantation using six-color based HLA-Flow method in pediatric acute leukemia.Rinsho Ketsueki,2017;58(7):729-737.
22 肖喜春,司金春,陈淑霞,等.老年急性髓系白血病患者化疗期间医院感染的危险因素及防治.中华实验和临床感染病杂志(电子版),2014;8(5):631-634.
2 白艳玲,李武平,刘冰,等.206例急性白血病化疗患者医院感染危险因素分析及护理对策.护理学报,2012;19(3):71-73.
3 黄先豹,卢玮,纪德香,等.急性白血病患者化疗后医院感染危险因素分析.中华医院感染学杂志,2014;24(7):1702-1704.
4 Bay C,González T,Munoz G,et al.Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia.Rev Chilena Infectol,2017;34(3):280-286.
5 Ohyama N,Torio M,Nakashima K,et al.A childhood-onset intestinal toxemia botulism during chemotherapy for relapsed acute?leukemia.Ann Clin Microbiol Antimicrob,2017;16(1):61.
6 孔兴美,周丽丽,叶蓉,等.急性白血病患者化疗后医院感染危险因素分析及护理.国际护理学杂志,2016;35(1):135-137.
7 Bay C,González T,Munoz G,et al.Nasal phaeohyphomycosis by Curvularia spicifera in pediatric patient with neutropenia and acute myeloid leukemia.Rev Chilena Infectol,2017;34(3):280-286.
8 杨荣,朱易萍,马志贵,等.儿童急性白血病化疗后院内感染危险因素分析.国际输血及血液学杂志,2013;36(5):395-397.
9 Sanna M,Caocci G,La Nasa G.How we manage invasive fungal disease in acute myeloid leukemia patients with glucose 6 dehydrogenase deficiency.Mediterr J Hematol Infect Dis,2017;9(1):2017-2027.
10 董洪婧,彭庆峰,张奎,等.急性白血病患者医院感染的危险因素分析.中华医院感染学杂志,2016;26(16):3724-3726.
11 Shah K,Curtin BF,Flasar MH,et al.Characteristics of Clostridium difficile infection in patients hospitalized with myelodysplastic syndrome or acute myelogenous leukemia.World J Clin Oncol,2017;8(5):398-404.
12 魏沄沄,张元元,甄英姿,等.儿童急性淋巴细胞白血病诱导化疗期导管相关性血栓发病及危险因素分析.中华血液学杂志,2017;38(4):313-317.
13 Ben Khelil M,Chkirbene Y,Mlika M,et al.Unexpected infant death secondary to a pulmonary infiltration due to acute myelocytic leukaemia.Malays J Pathol,2017;39(2):193-196.
14 周文锦,俞康,郑翠苹,等.白血病患者血流感染危险因素分析.中华医院感染学杂志,2013;23(22):5421-5422,5425.
15 Gharavi MJ,Roozbehani M,Mandeh Z.Detection of anti-Toxoplasma gondii antibodies in chronic myeloid leukemia and acute myeloid leukemia patients.Vet World,2017;10(9):1063-1065.
16 郎香花,黄健,章敏,等.急性白血病化疗患者血流感染的医源性危险因素分析.中华医院感染学杂志,2015;25(20):4696-4698.
17 Lucas N,Humble M,Sim D,et al.Temporal changes in neutropenic blood culture isolates and disease associations:a single centre series of 1139 episodes.Intern Med J,2017;47(8):962-965.
18 丁蓉芳,孙树梅.急性白血病患儿医院感染病原菌及危险因素分析.中国感染控制杂志,2015;14(5):325-328.
19 Tripathy K,Mittal K,Venkatesh P,et al.Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir.Oman J Ophthalmol,2017;10(3):250-252.
20 陈艳梅,孙卫东,代萍,等.老年急性白血病医院感染特点及危险因素分析.西部医学,2015;27(9):1340-1343.
21 Sakamoto K,Tomoyasu C,Yano M,et al.Monitoring of minimal residual disease after HLA-mismatched allogeneic hematopoietic stem cell transplantation using six-color based HLA-Flow method in pediatric acute leukemia.Rinsho Ketsueki,2017;58(7):729-737.
22 肖喜春,司金春,陈淑霞,等.老年急性髓系白血病患者化疗期间医院感染的危险因素及防治.中华实验和临床感染病杂志(电子版),2014;8(5):631-634.