急性白血病医院感染相关因素分析
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摘要
目的
探讨急性白血病(Acute leukemia,AL)医院感染的特点,通过病例回顾性研究建立AL医院感染非条件Logistic回归模型,寻找出独立的危险因素；然后制定针对性的预防措施,通过病例前瞻性研究验证该模型的可信性。
方法
对我院血液科2006年7月～2008年7月住院治疗的311例AL病例进行回顾性研究,填写统一的个案登记表。其中144例为医院感染(Nosocomial infection,NI)组,167例无任何感染者为非NI组,两组资料进行单因素卡方检验后,用非条件Logistic回归模型进行多元分析,筛选出AL NI的独立危险因素；对筛选出的可干预独立危险因素制定相应措施,对2008年8月-2009年12月的193例AL病例进行前瞻性研究,主要计算其NI发生率和死亡率,然后和采取相应措施的病例对比。
结果
采取措施前NI发生率为46.3%,死亡率为20.8%,采取措施后NI发生率为36.3%,死亡率为10%。感染部位以呼吸道、血液、口腔为主,感染部位不明患者亦占一定比例。导致感染的病原菌以革兰阴性菌为主占46.6%,革兰阴性菌对亚胺培南／西司他丁(泰能)、阿米卡星(丁胺卡那霉素)和头孢他啶较敏感,革兰阳性菌对万古霉素、阿米卡星较敏感。多因素分析结果筛选出年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是NI的独立危险因素。
结论
1.AL医院感染率高,预防和控制NI是提高AL治疗水平和延长患者生存期的重要方面。
2.致病菌多数为条件致病菌、耐药率较高,病情复杂,进展迅速,预后凶险,所以经验性抗生素治疗应以及时、高效、广谱、杀菌、有协同作用的抗生素联合,应用足够的剂量及期限为原则。
3.年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是AL医院感染的独立危险因素。
4.对外周血中性粒细胞绝对计数、住院天数、近期感染和住院季节采取的应对措施具有一定的可行性。
Objective
To investigate the characteristics of nosocomial infection in patients with acute leukemia and establish unconditional Logistic Regression Model using retrospective case study, search for independent risk factors and then take corresponding preventive measures to verify the credibility of this model through prospective case study.
Methods
Two groups of patients were analyzed in the current study:311 patients who were hospitalized and diagnosed AL at the Department of Hematology, Shandong Provincial Hospital from July 2006 to July 2008. Of the 311 AL patients,144 with nosocomial infections (NI group) and 167 without nosocomial infections (non-NI group) were analyzed using retrospective study. Univariate chi-square test and unconditional Logistic Regression Model multivariate analysis were carried out to screen NI independent risk factors. 193 patients diagnosed AL from August 2008 to December 2009 were then taken corresponding preventive measures and studied using prospective study. NI incidence rate and mortality rate were calculated and compared with that in patients without corresponding preventive measures.
Results
NI incidence rate and mortality rate were decreased obviously accepted preventive measures (36.3%,10%) when compared with patients without corresponding preventive measures (46.3%,20.8%). The incidence of nosocomial infection was 46.3%(144/311), mainly consisting of respiratory tract, blood and oral infection. No recognized sites could be found in certain patients with nosocomial infection. The most common pathogens were gram-negative bacilli(46.6%), which were relatively sensitive to Imipenem/Cilastatin Sodium(TIENAM), Amikacin, Ceftazidine. The gram-positive cocci were relatively sensitive to Vancomycin and Ceftazidine. The analyzed results show that age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization were found as independent risk factors of nosocomial infection.
Conclusions
1. The incidence of nosocomial infection in patients with acute leukemia is high. In order to reduce the death rate, improve level of therapy and prolong survival periods of these patients, positive measures should be taken to prevent and treat nosocomial infection.
2. The conditional pathogenic bacteria are the main pathogens in nosocomial infections in patients with acute leukemia, and most of them are resisted to antibiotics. As infections in these patients are usually severe and complicated, with poor prognosis, so antibiotics selection upon experiences should be taken rapidly. General principles of antimicrobial therapy should also be applied, including administration in time, high-effective, broad-spectral and bactericidal drug combination. Adequate dosage and duration of antimicrobial therapy are also important.
3. Age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization are independent risk factors for nosocomial infection in patients with acute leukemia.
4. Corresponding measures against neutrophil number in peripheral blood, admission day, recent infection and season have some feasibility.
探讨急性白血病(Acute leukemia,AL)医院感染的特点,通过病例回顾性研究建立AL医院感染非条件Logistic回归模型,寻找出独立的危险因素；然后制定针对性的预防措施,通过病例前瞻性研究验证该模型的可信性。
方法
对我院血液科2006年7月～2008年7月住院治疗的311例AL病例进行回顾性研究,填写统一的个案登记表。其中144例为医院感染(Nosocomial infection,NI)组,167例无任何感染者为非NI组,两组资料进行单因素卡方检验后,用非条件Logistic回归模型进行多元分析,筛选出AL NI的独立危险因素；对筛选出的可干预独立危险因素制定相应措施,对2008年8月-2009年12月的193例AL病例进行前瞻性研究,主要计算其NI发生率和死亡率,然后和采取相应措施的病例对比。
结果
采取措施前NI发生率为46.3%,死亡率为20.8%,采取措施后NI发生率为36.3%,死亡率为10%。感染部位以呼吸道、血液、口腔为主,感染部位不明患者亦占一定比例。导致感染的病原菌以革兰阴性菌为主占46.6%,革兰阴性菌对亚胺培南／西司他丁(泰能)、阿米卡星(丁胺卡那霉素)和头孢他啶较敏感,革兰阳性菌对万古霉素、阿米卡星较敏感。多因素分析结果筛选出年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是NI的独立危险因素。
结论
1.AL医院感染率高,预防和控制NI是提高AL治疗水平和延长患者生存期的重要方面。
2.致病菌多数为条件致病菌、耐药率较高,病情复杂,进展迅速,预后凶险,所以经验性抗生素治疗应以及时、高效、广谱、杀菌、有协同作用的抗生素联合,应用足够的剂量及期限为原则。
3.年龄、糖皮质激素、外周血中性粒细胞绝对计数、化疗周期、住院天数、治疗阶段、近期感染和住院季节是AL医院感染的独立危险因素。
4.对外周血中性粒细胞绝对计数、住院天数、近期感染和住院季节采取的应对措施具有一定的可行性。
Objective
To investigate the characteristics of nosocomial infection in patients with acute leukemia and establish unconditional Logistic Regression Model using retrospective case study, search for independent risk factors and then take corresponding preventive measures to verify the credibility of this model through prospective case study.
Methods
Two groups of patients were analyzed in the current study:311 patients who were hospitalized and diagnosed AL at the Department of Hematology, Shandong Provincial Hospital from July 2006 to July 2008. Of the 311 AL patients,144 with nosocomial infections (NI group) and 167 without nosocomial infections (non-NI group) were analyzed using retrospective study. Univariate chi-square test and unconditional Logistic Regression Model multivariate analysis were carried out to screen NI independent risk factors. 193 patients diagnosed AL from August 2008 to December 2009 were then taken corresponding preventive measures and studied using prospective study. NI incidence rate and mortality rate were calculated and compared with that in patients without corresponding preventive measures.
Results
NI incidence rate and mortality rate were decreased obviously accepted preventive measures (36.3%,10%) when compared with patients without corresponding preventive measures (46.3%,20.8%). The incidence of nosocomial infection was 46.3%(144/311), mainly consisting of respiratory tract, blood and oral infection. No recognized sites could be found in certain patients with nosocomial infection. The most common pathogens were gram-negative bacilli(46.6%), which were relatively sensitive to Imipenem/Cilastatin Sodium(TIENAM), Amikacin, Ceftazidine. The gram-positive cocci were relatively sensitive to Vancomycin and Ceftazidine. The analyzed results show that age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization were found as independent risk factors of nosocomial infection.
Conclusions
1. The incidence of nosocomial infection in patients with acute leukemia is high. In order to reduce the death rate, improve level of therapy and prolong survival periods of these patients, positive measures should be taken to prevent and treat nosocomial infection.
2. The conditional pathogenic bacteria are the main pathogens in nosocomial infections in patients with acute leukemia, and most of them are resisted to antibiotics. As infections in these patients are usually severe and complicated, with poor prognosis, so antibiotics selection upon experiences should be taken rapidly. General principles of antimicrobial therapy should also be applied, including administration in time, high-effective, broad-spectral and bactericidal drug combination. Adequate dosage and duration of antimicrobial therapy are also important.
3. Age, corticosteroids therapy, absolute neutrophil count in peripheral blood, cycles of chemotherapy, length of hospitalization, stages of treatment, the latest infections and seasons of hospitalization are independent risk factors for nosocomial infection in patients with acute leukemia.
4. Corresponding measures against neutrophil number in peripheral blood, admission day, recent infection and season have some feasibility.
引文
1. Cornelissen JJ,van Puttern WL,Verdonck LF,et al.Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults:benefits for whom?[J]. Blood,2007,109(9):3658-3666.
2.辛碧珍,杨婷,吕联煌,等.86例急性白血病患者死亡情况分析[J]白血病杂志,2000,9(5)：279-281.
3.孙晓非,刘东耕,甄子俊,等.短疗程高强度化疗方案治疗儿童青少年非何杰金氏淋巴瘤的治疗[J].中华血液杂志,2005,26(10)：581-584.
4.夏震,沈杨,李军民,等.165例急性白血病死亡原因回顾[J].内科理论与实践,2007,2(1)：30-33.
5. Stalfelt AM. A "good death" needs to be discussed. A study of patients with acute myeloid leukemia demonstrates the value of palliative care [J].Lakartidningen,2003,100(49):4072-4077.
6.林宝爵.急性白血病.见：邓家栋等主编《临床血液学》.上海：上海科技出版社,2001：975-997.
7. Plowman R,Graves N,Griffin MAS,et al.The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialities of a district general Hospital in England the national burden imposed[J].Hosp Infect,2001,47:198-202.
8.刘振声.医院感染管理学.北京：军事医学科学出版社,2000：25-27.
9.中华人民共和国卫生部.2001医院感染诊断标准.中华医学杂志,2001,81(5)：28-31.
10.陈灏珠.实用内科学[M].第10版.北京：人民卫生出版社,1997：645-646.
11. Devita VT Jr,Hellman S,Rosenberg SA, eds.Cancer principal& practice of oncology [M].4th ed.Philadelphia:J.B.Lippincott Company,1993, 2293-2294.
12.张淑彩,郭晓,魏晓丽.恶性血液病患者医院感染的研究进展[J].中华医院感染学杂志,2005,15(12)：1435-1437.
13. Petrilli AS,Melaragno R,Baros KV,et al.Fever and neutropenia in children with cancer:a therapeutic approach related to the underlying disease[J]. Pediatr Infect Dis J,1993,12(1):916-921.
14.任金海,张静楠,王艳,等.急性白血病106例化疗后感染的治疗对策[J].中国实用内科杂志,2005,25(10)：924-925.
15. Perl TM. Surveillance, reporting, and the use of computers. In:Wenzel RP. Eds. Prevention and control of nosocomial infections[M].3rd ed. Baltimore:Walliams& Wilkins.1997.127.
16. Katsimpardi K, Papadakis V, Pangalis A, et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment [J]. Support Care Cancer,2006,14(3):277-284.
17. Gulay Sain Guven,Omrum Uzun,Banu Cakir,et al.Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team:a retrospective cohort study(1997-2001). Support Care Cancer,2006,14(1):52-55.
18.艾丽梅,张欣,阎曼.恶性血液病患者医院感染回顾性分析[J].中华医院感染学杂志,2007,17(10)：1224-1225.
19.文细毛,任南,吴安华,等.全国医院感染监控网白血病患者医院感染资料分析[J].中国感染控制杂志,2006,5(1)：29-31.
20.彭文伟.现代感染性疾病与传染病学.北京：北京科学出版社,2000：9.
21. Aoun M, Crodaert F, Paesmans M, et al. Imipenem versus targeted therapy in cancer patients[J]. Int J Antimicrob Agents,1998,10(4):263.
22. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy:aetiology, prevention, and treatment [J]. Lancet On2col, 2003,4 (10):595-604.
23. Girmenia C,Cocol FL,Breccia M,et al. Infectious complications in patients with acute promyelocytic leukemia treated with the AIDA regimen[J]. Leukemia,2003,17:925-930.
24.石红霞,黄晓军,王峰容,等.急性白血病患者粒细胞缺乏时发热的经验治疗[J].中国抗感染化疗杂志,2004,4：209-212.
25. Guven GS,Uzun O,Cakir B,et al. Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team:a retrospective cohort study(1997-2001)[J]. Support Care Cancer.2006,14: 52-55.
26. Kern WV,Klose KJellen-Ritter AS,et al. Fluoroquinolone resistance of Escherichia coli at a cancer center:epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia[J]. Eur J Clin Microbiol Infect Dis.2005,24:111-118.
27. Urrea M,Rives S,Cruz O, et al.Nosocomial infection among pediatric hematology/oncology patients:results of a prospective incidence study. Am J Infect Control,2004,32:205-208.
28.吴安华,,任南,文细毛.全国医院监控网1998-1999年监测资料分析[J].中华医院感染学杂志,2000,10(6).40.
29.吴超.革兰阳性菌医院感染的现状和控制对策[J].中华医院感染学杂志,2002,12(2)：158-160.
30. Cornely O A,Ullmann A J,Karthaus M.Comment on:Evidence-based review of antifungal prophylaxis in neutropenic patients with haematological malignancies J Antimicrob Chemother.2006,57:151-152.
31.文细毛,任南,吴安华,等.白血病患者医院感染1 310株病原菌分布及耐药性分析[J].中华医院感染学杂志,2005,15(1)：96-99.
32.常乃柏,胡云剑,刘辉,等.血液肿瘤患者医院获得性感染细菌病原学研究[J].中华医院感染学杂志,2002,12(3)：161-163.
33. Jones WG, Barber AE, Minei JP, et al.Antibiotic prophylaxis diminishes bacterial translocation but not mortality in experimental burn wound sepsis[J]. Trauma,1990,30:737.
34.杨洁,聂青和.肠道细菌移位研究现状[J].中国实用内科杂志,2009,29(6)：563-565.
35.夏德发,杨卫华．内源性医院感染发病研究[J].中华医院感染学杂志, 2002,12(3)：238-240
36.张亚莉,杨云滨,汪能平,等.危重患者医院感染临床调查分析[J].中华医院感染学杂志,2003,13(2)：120-123.
37. Ogle JW, Reller LB, Vasil ML. Development of resistance in Pseudomonas aeruginosa to imipenem, norfloxacin, and ciprofloxacin during therapy:proof provided by typing with a DNA probe [J]. Infect Dis, 1988,157:743-748.
38. Troillet N, Samore MH, Carmeli Y. Imipenem-resistant Pseudomonas agruginosa:risk factors and antibiotic susceptibility patterns[J]. Clin Infect Dis,1997,25:1094-1098.
39.汪复,朱德妹,胡付品,等.上海地区细菌耐药性监测分析[J].中华医学杂志,2001,81：17-19.
40.齐桂云,孙琪,王喜尧,等.鲍曼不动杆菌的临床分布及耐药性分析[J].中国卫生检验杂志,2008,18(1)：113-114.
41. Worth LJ,Thursky KA,Seymour JF,et al.Vancomycin-resistant Enterocous faecium infection in patient with hematologic malignancy:patients with acute myeloid leukemia are at high-risk[J]..Eur J Haematol. 2007,79(3):226-233.
42. Ricgards MJ, Edwards JR. Nosocomial infections in medical inensive care units in the United States. National nosocomial Infections Surveillance System. Crit Care Med,1999,27(5):853-854.
43.汪复,吴缇,朱德妹.1998年上海地区细菌耐药性监测[J].中华内科杂志,1999,38：729-732.
44.汪复,朱德妹,张婴元.上海部分医院细菌耐药性监测及其临床意义[J].中华传染病杂志,1996,14：148-151.
45.汪复.革兰阳性细菌的耐药机制及其治疗对策[J].中华医学杂志,1998,78：236-237.
46.郑姬,府伟灵,张晓兵.尿路感染常见病原菌的分布及耐用性分析[J].中华医院感染学杂志,2006,16(11)：1294-1296.
47. Pittet D, Dharan S, Toureneau S, et al. Bacterial contamination of the
hands of hospital staff during routing patient care[J]. Arch Intern Med,1999,159:821-826.
48. Fred c, Enover PhD, James M. The challenges of emerging infectious disease-development and spread of multiply-resistant bacterial pathogens[J]. JAMA,1996,15(4):199.
49.陈民钧.细菌耐药性及其临床意义[J].中华外科杂志,1998,36(增刊)：6-8.
50.黄怡.常用抗菌药物耐药机制及对策[J].国外医学抗生素分册,1999,21 (1)：28-31.
51.陆道培.白血病治疗学.北京：科学出版社,1992.
52.李同度.临床肿瘤学.合肥：安徽科学技术出版社,1995.
53.张天泽,徐光伟.肿瘤学.天津：天津科学技术出版社,1996.
54. Song JH, Lee NY, Ichiyama S, et al. Spread of drug-resistant Streptococcus pneumoniae in Asian countries:Asian network for Surveillance of Resistant Pathogens(ANSORP) Study. Clin Infect Dis,1999,28:1206-1211.
55. Paterson DL, Ko WC, Gotiber AV, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended spectrum β-lactamases:implications to the clinical microbiology[J]. Clin Microbiol,2000,39:2206-2212.
56. Kroper A, Lemmen SW, Grundmawn HJ, et al. Synergy of simultaneous administration of ofloxacin and granulocyte cology-stimulating factor in killing of escherichia coli by human neutrophils. Infection,1995,23(5)：298.
57.屈玲,府伟灵.急性白血病化疗后医院感染及抗感染治疗分析[J].中华医院感染学杂志,2005,15(4)：399-401.
58.胡永军,刘景洪,刘红.急性白血病96例并发医院感染临床分析.南通大学学报,2005,25(6)：460-461.
59.孙鸿霞.儿童急性白血病合并医院感染的易感因素探讨[J].中国实用医药,2008,3(29)：160-161.
60.季海生,朱德全..老年患者下呼吸道感染痰培养前瞻性研究[J].中华医院感染学杂志,2005,15(11)：1237-1240.
61.柴铁,李骏,刘庆荣,等.老年急性髓系白血病化疗后医院感染的危险因素及临床分析[J].2009,19(9)：1051-1054.
62.王军,张新华,周敏,等.急性白血病化疗后医院感染及抗感染治疗分析[J].临床血液学杂志,2007,20(6)：339-340
63.庞丽萍,杨保青,孟庆祥,等.急性白血病合并感染123例临床分析[J].中华医院感染学杂志,2006,16(2)：149-151.
64. Bodey GP, Powell RD, Hersh EM, et al. Pulmonary complocation of acute leukemia [J]. Cancer,1996,19:781-783.
65.薛艳萍,卞寿庚,赵耀中,等.急性白血病诱导化疗合并院内感染100例临床分析[J].新医学,1997,28(11)：598-599.
66. Bonilla MA, Dale D, Zeidler C, et al. Long-tern safety of treatment with recombinant human granulocyte colony-stimulating factor(γ-metHug-CSF) in patients with severe congenital neutropenias. Br J Haematol,1994,88:723.
67. Schmitz S.Franke H, Wichmann HE, et al. The effect of continuous G-CSF application in human cyctic neutropenia:a model analysis. Br J Haematol, 1995,90:41.
68.杨清明,彭朝津,苏琴,等.老年肿瘤患者化疗后急性粒细胞缺乏症的救治[J].中国感染控制杂志,2004,3(4)：320-321.
69.陈旭芳.粒细胞集落刺激因子对肿瘤化疗患者白细胞数及医院感染的影响[J].中国肿瘤临床与康复,2009,16(3)：196-198.
70. Nemunaitis J. A comparative review of colang-stimulating factors[J]. ADrugs,1997,54(5);174.
71.刘润生,罗建民,姚尔固,等.急性白血病与医院内感染-附106例报告[J].山西白血病,1994,3(1)：59-61.
72.程伏林,胡名柏,袁宏银,等.化疗所致粒细胞缺乏症患者医院感染危险因素的多因素Cox模型分析[J].中华医院感染学杂志,2002,12(5)：327-328.
73. Chanock SJ, Pizzo PA. Infectious complications of patient undergoing therapy for acute leukemia:current status and future prospects. Semi Oncol.1997,24(1):132-140.
74.李宗麟,邓小虹.医院感染与消毒[J].中华医院感染学杂志,2000,10(1)：78-80.
75.陈秀英.不同季节医院感染发病的研究[J].中华医院感染学杂志,2003,13(9)：833-834.
76.胡龙华,王文丁,贾坤如等.血液病患者医院感染与白细胞数关系的研究[J].中华医院感染学杂志,2002,12(3)：191-192.
77. Ehninger G, Schuler HK, Sarnow E. Fluconazole in the prophylaxis of fungal infection after bone marrow transplantation [J]. Mycoses, 1996,39:259.
78.方会涛,付菊芳,白燕妮等.全环境保护预防恶性血液病患者大剂量化疗后感染的效果评价[J].现代护理,2004,10(8)：695-696.钟秀玲,刘君卓,李小英,等.空气消毒净化方法研究[J].中国护理杂志,1999,34(9)：529.
2.辛碧珍,杨婷,吕联煌,等.86例急性白血病患者死亡情况分析[J]白血病杂志,2000,9(5)：279-281.
3.孙晓非,刘东耕,甄子俊,等.短疗程高强度化疗方案治疗儿童青少年非何杰金氏淋巴瘤的治疗[J].中华血液杂志,2005,26(10)：581-584.
4.夏震,沈杨,李军民,等.165例急性白血病死亡原因回顾[J].内科理论与实践,2007,2(1)：30-33.
5. Stalfelt AM. A "good death" needs to be discussed. A study of patients with acute myeloid leukemia demonstrates the value of palliative care [J].Lakartidningen,2003,100(49):4072-4077.
6.林宝爵.急性白血病.见：邓家栋等主编《临床血液学》.上海：上海科技出版社,2001：975-997.
7. Plowman R,Graves N,Griffin MAS,et al.The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialities of a district general Hospital in England the national burden imposed[J].Hosp Infect,2001,47:198-202.
8.刘振声.医院感染管理学.北京：军事医学科学出版社,2000：25-27.
9.中华人民共和国卫生部.2001医院感染诊断标准.中华医学杂志,2001,81(5)：28-31.
10.陈灏珠.实用内科学[M].第10版.北京：人民卫生出版社,1997：645-646.
11. Devita VT Jr,Hellman S,Rosenberg SA, eds.Cancer principal& practice of oncology [M].4th ed.Philadelphia:J.B.Lippincott Company,1993, 2293-2294.
12.张淑彩,郭晓,魏晓丽.恶性血液病患者医院感染的研究进展[J].中华医院感染学杂志,2005,15(12)：1435-1437.
13. Petrilli AS,Melaragno R,Baros KV,et al.Fever and neutropenia in children with cancer:a therapeutic approach related to the underlying disease[J]. Pediatr Infect Dis J,1993,12(1):916-921.
14.任金海,张静楠,王艳,等.急性白血病106例化疗后感染的治疗对策[J].中国实用内科杂志,2005,25(10)：924-925.
15. Perl TM. Surveillance, reporting, and the use of computers. In:Wenzel RP. Eds. Prevention and control of nosocomial infections[M].3rd ed. Baltimore:Walliams& Wilkins.1997.127.
16. Katsimpardi K, Papadakis V, Pangalis A, et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment [J]. Support Care Cancer,2006,14(3):277-284.
17. Gulay Sain Guven,Omrum Uzun,Banu Cakir,et al.Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team:a retrospective cohort study(1997-2001). Support Care Cancer,2006,14(1):52-55.
18.艾丽梅,张欣,阎曼.恶性血液病患者医院感染回顾性分析[J].中华医院感染学杂志,2007,17(10)：1224-1225.
19.文细毛,任南,吴安华,等.全国医院感染监控网白血病患者医院感染资料分析[J].中国感染控制杂志,2006,5(1)：29-31.
20.彭文伟.现代感染性疾病与传染病学.北京：北京科学出版社,2000：9.
21. Aoun M, Crodaert F, Paesmans M, et al. Imipenem versus targeted therapy in cancer patients[J]. Int J Antimicrob Agents,1998,10(4):263.
22. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy:aetiology, prevention, and treatment [J]. Lancet On2col, 2003,4 (10):595-604.
23. Girmenia C,Cocol FL,Breccia M,et al. Infectious complications in patients with acute promyelocytic leukemia treated with the AIDA regimen[J]. Leukemia,2003,17:925-930.
24.石红霞,黄晓军,王峰容,等.急性白血病患者粒细胞缺乏时发热的经验治疗[J].中国抗感染化疗杂志,2004,4：209-212.
25. Guven GS,Uzun O,Cakir B,et al. Infectious complications in patients with hematological malignancies consulted by the Infectious Diseases team:a retrospective cohort study(1997-2001)[J]. Support Care Cancer.2006,14: 52-55.
26. Kern WV,Klose KJellen-Ritter AS,et al. Fluoroquinolone resistance of Escherichia coli at a cancer center:epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia[J]. Eur J Clin Microbiol Infect Dis.2005,24:111-118.
27. Urrea M,Rives S,Cruz O, et al.Nosocomial infection among pediatric hematology/oncology patients:results of a prospective incidence study. Am J Infect Control,2004,32:205-208.
28.吴安华,,任南,文细毛.全国医院监控网1998-1999年监测资料分析[J].中华医院感染学杂志,2000,10(6).40.
29.吴超.革兰阳性菌医院感染的现状和控制对策[J].中华医院感染学杂志,2002,12(2)：158-160.
30. Cornely O A,Ullmann A J,Karthaus M.Comment on:Evidence-based review of antifungal prophylaxis in neutropenic patients with haematological malignancies J Antimicrob Chemother.2006,57:151-152.
31.文细毛,任南,吴安华,等.白血病患者医院感染1 310株病原菌分布及耐药性分析[J].中华医院感染学杂志,2005,15(1)：96-99.
32.常乃柏,胡云剑,刘辉,等.血液肿瘤患者医院获得性感染细菌病原学研究[J].中华医院感染学杂志,2002,12(3)：161-163.
33. Jones WG, Barber AE, Minei JP, et al.Antibiotic prophylaxis diminishes bacterial translocation but not mortality in experimental burn wound sepsis[J]. Trauma,1990,30:737.
34.杨洁,聂青和.肠道细菌移位研究现状[J].中国实用内科杂志,2009,29(6)：563-565.
35.夏德发,杨卫华．内源性医院感染发病研究[J].中华医院感染学杂志, 2002,12(3)：238-240
36.张亚莉,杨云滨,汪能平,等.危重患者医院感染临床调查分析[J].中华医院感染学杂志,2003,13(2)：120-123.
37. Ogle JW, Reller LB, Vasil ML. Development of resistance in Pseudomonas aeruginosa to imipenem, norfloxacin, and ciprofloxacin during therapy:proof provided by typing with a DNA probe [J]. Infect Dis, 1988,157:743-748.
38. Troillet N, Samore MH, Carmeli Y. Imipenem-resistant Pseudomonas agruginosa:risk factors and antibiotic susceptibility patterns[J]. Clin Infect Dis,1997,25:1094-1098.
39.汪复,朱德妹,胡付品,等.上海地区细菌耐药性监测分析[J].中华医学杂志,2001,81：17-19.
40.齐桂云,孙琪,王喜尧,等.鲍曼不动杆菌的临床分布及耐药性分析[J].中国卫生检验杂志,2008,18(1)：113-114.
41. Worth LJ,Thursky KA,Seymour JF,et al.Vancomycin-resistant Enterocous faecium infection in patient with hematologic malignancy:patients with acute myeloid leukemia are at high-risk[J]..Eur J Haematol. 2007,79(3):226-233.
42. Ricgards MJ, Edwards JR. Nosocomial infections in medical inensive care units in the United States. National nosocomial Infections Surveillance System. Crit Care Med,1999,27(5):853-854.
43.汪复,吴缇,朱德妹.1998年上海地区细菌耐药性监测[J].中华内科杂志,1999,38：729-732.
44.汪复,朱德妹,张婴元.上海部分医院细菌耐药性监测及其临床意义[J].中华传染病杂志,1996,14：148-151.
45.汪复.革兰阳性细菌的耐药机制及其治疗对策[J].中华医学杂志,1998,78：236-237.
46.郑姬,府伟灵,张晓兵.尿路感染常见病原菌的分布及耐用性分析[J].中华医院感染学杂志,2006,16(11)：1294-1296.
47. Pittet D, Dharan S, Toureneau S, et al. Bacterial contamination of the
hands of hospital staff during routing patient care[J]. Arch Intern Med,1999,159:821-826.
48. Fred c, Enover PhD, James M. The challenges of emerging infectious disease-development and spread of multiply-resistant bacterial pathogens[J]. JAMA,1996,15(4):199.
49.陈民钧.细菌耐药性及其临床意义[J].中华外科杂志,1998,36(增刊)：6-8.
50.黄怡.常用抗菌药物耐药机制及对策[J].国外医学抗生素分册,1999,21 (1)：28-31.
51.陆道培.白血病治疗学.北京：科学出版社,1992.
52.李同度.临床肿瘤学.合肥：安徽科学技术出版社,1995.
53.张天泽,徐光伟.肿瘤学.天津：天津科学技术出版社,1996.
54. Song JH, Lee NY, Ichiyama S, et al. Spread of drug-resistant Streptococcus pneumoniae in Asian countries:Asian network for Surveillance of Resistant Pathogens(ANSORP) Study. Clin Infect Dis,1999,28:1206-1211.
55. Paterson DL, Ko WC, Gotiber AV, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended spectrum β-lactamases:implications to the clinical microbiology[J]. Clin Microbiol,2000,39:2206-2212.
56. Kroper A, Lemmen SW, Grundmawn HJ, et al. Synergy of simultaneous administration of ofloxacin and granulocyte cology-stimulating factor in killing of escherichia coli by human neutrophils. Infection,1995,23(5)：298.
57.屈玲,府伟灵.急性白血病化疗后医院感染及抗感染治疗分析[J].中华医院感染学杂志,2005,15(4)：399-401.
58.胡永军,刘景洪,刘红.急性白血病96例并发医院感染临床分析.南通大学学报,2005,25(6)：460-461.
59.孙鸿霞.儿童急性白血病合并医院感染的易感因素探讨[J].中国实用医药,2008,3(29)：160-161.
60.季海生,朱德全..老年患者下呼吸道感染痰培养前瞻性研究[J].中华医院感染学杂志,2005,15(11)：1237-1240.
61.柴铁,李骏,刘庆荣,等.老年急性髓系白血病化疗后医院感染的危险因素及临床分析[J].2009,19(9)：1051-1054.
62.王军,张新华,周敏,等.急性白血病化疗后医院感染及抗感染治疗分析[J].临床血液学杂志,2007,20(6)：339-340
63.庞丽萍,杨保青,孟庆祥,等.急性白血病合并感染123例临床分析[J].中华医院感染学杂志,2006,16(2)：149-151.
64. Bodey GP, Powell RD, Hersh EM, et al. Pulmonary complocation of acute leukemia [J]. Cancer,1996,19:781-783.
65.薛艳萍,卞寿庚,赵耀中,等.急性白血病诱导化疗合并院内感染100例临床分析[J].新医学,1997,28(11)：598-599.
66. Bonilla MA, Dale D, Zeidler C, et al. Long-tern safety of treatment with recombinant human granulocyte colony-stimulating factor(γ-metHug-CSF) in patients with severe congenital neutropenias. Br J Haematol,1994,88:723.
67. Schmitz S.Franke H, Wichmann HE, et al. The effect of continuous G-CSF application in human cyctic neutropenia:a model analysis. Br J Haematol, 1995,90:41.
68.杨清明,彭朝津,苏琴,等.老年肿瘤患者化疗后急性粒细胞缺乏症的救治[J].中国感染控制杂志,2004,3(4)：320-321.
69.陈旭芳.粒细胞集落刺激因子对肿瘤化疗患者白细胞数及医院感染的影响[J].中国肿瘤临床与康复,2009,16(3)：196-198.
70. Nemunaitis J. A comparative review of colang-stimulating factors[J]. ADrugs,1997,54(5);174.
71.刘润生,罗建民,姚尔固,等.急性白血病与医院内感染-附106例报告[J].山西白血病,1994,3(1)：59-61.
72.程伏林,胡名柏,袁宏银,等.化疗所致粒细胞缺乏症患者医院感染危险因素的多因素Cox模型分析[J].中华医院感染学杂志,2002,12(5)：327-328.
73. Chanock SJ, Pizzo PA. Infectious complications of patient undergoing therapy for acute leukemia:current status and future prospects. Semi Oncol.1997,24(1):132-140.
74.李宗麟,邓小虹.医院感染与消毒[J].中华医院感染学杂志,2000,10(1)：78-80.
75.陈秀英.不同季节医院感染发病的研究[J].中华医院感染学杂志,2003,13(9)：833-834.
76.胡龙华,王文丁,贾坤如等.血液病患者医院感染与白细胞数关系的研究[J].中华医院感染学杂志,2002,12(3)：191-192.
77. Ehninger G, Schuler HK, Sarnow E. Fluconazole in the prophylaxis of fungal infection after bone marrow transplantation [J]. Mycoses, 1996,39:259.
78.方会涛,付菊芳,白燕妮等.全环境保护预防恶性血液病患者大剂量化疗后感染的效果评价[J].现代护理,2004,10(8)：695-696.钟秀玲,刘君卓,李小英,等.空气消毒净化方法研究[J].中国护理杂志,1999,34(9)：529.