摘要
目的探讨粒细胞缺乏合并败血症患者的病原学及临床特点。方法回顾性分析2018年9月-2020年12月中山大学附属第七医院30例粒细胞缺乏合并血培养阳性病例的病原学特点、临床表现、感染部位、感染相关因素及治疗转归。结果共检出粒细胞缺乏合并败血症患者菌株30株,革兰阴性菌(G^(-)菌)占73.3%,其中前三位为大肠埃希菌、肺炎克雷伯杆菌和铜绿假单胞菌;革兰阳性菌(G^(+)菌)占26.7%,前两位为葡萄球菌、肠球菌。检出多重耐药菌10例(占33.3%),其中产超广谱β内酰胺酶(ESBL)阳性大肠埃希菌3例(占37.5%)、耐碳青霉烯类的肠杆菌科细菌(CRE)5例(占22.7%),耐甲氧西林金黄色葡萄球菌(MRSA)2例(占25.0%)。所有病例均合并发热,其中高热及超高热起病患者(>39℃)占70.0%,常见感染部位为肺部(占76.7%)、肛周、上呼吸道、软组织、口腔,5例患者无明确感染灶(占16.7%);发热2 h内早期予经验性用药,后续根据药敏结果调整抗生素用药,23例患者病情控制出院,7例患者病情恶化自动出院后死亡,总体临床治愈率76.7%,治疗有效组患者粒细胞缺乏持续时间(中位时间6 d)显著低于治疗效果不佳组(中位时间23 d),差异有统计学意义(χ^(2)=9.966,P=0.002)。结论粒细胞缺乏合并败血症患者的病原菌种类多样,以G-菌为主,耐药情况严重,了解病原菌分布及耐药情况、早期经验性抗感染治疗并积极缩短粒缺持续时间可明显改善患者预后。
Objective To study the etiology and clinical features of hematological neutropenic patients with septicemia.Methods From September 2018 to December 2020,the etiology,clinical manifestations,infection site,infection relatedfactors and therapeutic outcome of 30 cases of hematological neutropenic patients in the Seventh Affiliated Hospital of SunYat-sen University with positive blood culture outcome were analyzed retrospectively.Results A total of 30 cases ofneutropenic patients with septicemia were studied.Gram-negative bacteria(G^(-))accounted for 73.3%;the first three wereEscherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa.Gram-positive bacteria(G^(+))accounted for 26.7%;thefirst two were Staphylococcus and Enterococcus.Multidrug-resistant bacteria were detected in 10 cases(33.3%).Of which,3cases(37.5%)were extended-spectrumβ-lactamase(ESBL)-positive Escherichia coli and 5 cases(22.7%)were bacteriaresistant to carbapenem(CRE),2 cases(25.0%)were methicillin-resistant Staphylococcus aureus(MRSA).All cases hadfever;patients with high fever and ultra high fever(T>39℃)accounted for 70.0%.Common infection sites were lung(76.7%),perianal,upper respiratory tract,soft tissue and oral cavity.No definite infection site in 5 patients(16.7%).Early empirical therapy within 2 hours and adjust antibiotic was used according to drug sensitivity results.23 patients weredischarged under control;seven patients died after automatic discharge;the overall clinical cure rate was 76.7%.Neutropenic deficiency duration(median time 6 days)in the effective group was significantly lower than that in the lesseffective one(median time 23 days)(χ^(2)=9.966,P=0.002).Conclusions There were various types of pathogenic bacteriain hematological neutropenia patients with sepsis,mainly G-bacteria,and the drug resistance was serious.Understandingthe distribution and drug resistance of pathogens,early empirical anti-infection treatment and actively shortening theduration of neutropenia could significantly improve the patient’s prognosis.
作者
黄玉玲
卢博
许晓军
林东军
曾芸馨
HUANG Yuling;LU Bo;XU Xiaojun;LIN Dongjun;ZENG Yunxin(Department of Hematology,the Seventh Affiliated Hospital of Sun Yat⁃sen University,Shenzhen,Guangdong 518107,China)
出处
《热带医学杂志》
CAS
2023年第2期256-258,共3页
Journal of Tropical Medicine
基金
深圳市‘医疗卫生三名工程’项目资助(SZSM201911004)
关键词
粒细胞缺乏
败血症
多重耐药菌
Neutropenic
Septicemia
Multidrug resistant-bacteria
作者简介
黄玉玲(1991-),女,硕士,主要从事急性白血病相关研究;通信作者:曾芸馨,E⁃mail:zeng_0714@163.com
