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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。
Objective: To analyze the clinical features, risk factors and characteristics of pathogenic strains in patients with newly diagnosed acute leukemia after receiving the first induction chemotherapy (chemotherapy). Methods: A retrospective study was conducted to analyze the clinical data of 258 newly diagnosed acute leukemia patients hospitalized in our department from October 2013 to February 2015. All patients received standard induction chemotherapy and were given routine care. Fever are in accordance with our country neutrophilic granulomatosis (fever) patients with antimicrobial agents clinical guidelines for microbiological examination and initial experience of antimicrobial drug treatment, according to the results of microbiological test to adjust the type of antimicrobial drugs. Statistical analysis of the clinical features of bloodstream infections and related risk factors. Results: In the group of 17 patients with newly diagnosed acute leukemia who underwent induction chemotherapy, 17 cases were infected with bloodstream, the incidence was 6.58%. The incidence of bloodstream infections in the elderly (≥60 years) and non-elderly (≤60 years) patients was 18.6% and 0.58%, respectively (P = 0.013). The incidence of bloodstream infections in the long-term and short-term group was 9.38% and 2.04%, respectively (P = 0.021). The high interleukin (IL) -6, IL-8, tumor necrosis factor (TNF) α and blood β2 microglobulin all indicate the high incidence of bloodstream infection. Gram-negative pathogens mainly bacteria, cephalosporin 3 generations more common. Lack of duration, decreased number of T cells before chemotherapy and blood β2 microglobulin increased risk factors for infection. Conclusions: The incidence of combined bloodstream infection in patients with acute leukemia after induction chemotherapy is high. The duration of granuloma after chemotherapy, the number of T cells before chemotherapy and elevated serum β2-microglobulin are risk factors for infection. Positive precautionary measures should be taken and the initial selection of the initial antimicrobial agents should be empirically based on the characteristics of the pathogen of the bloodstream infection Improve the efficiency of blood infection treatment.