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目的探讨急性白血病下呼吸道感染病原菌分布及耐药性,并分析造成下呼吸道感染的危险因素,为临床治疗提供参考。方法选择87例急性白血病住院患者作为研究对象,收集其痰液标本,进行病原菌培养与药敏试验;采用logistic回归分析急性白血病患者下呼吸道感染的危险因素。结果发生下呼吸道感染共40例,检出革兰阴性菌占67.21%,革兰阳性菌占24.59%,真菌占8.20%,菌种主要为肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌及鲍氏不动杆菌;检出病原菌对多种抗菌药物耐药,肺炎克雷伯菌对亚胺培南及美罗培南敏感,耐药率分别为18.75%以及12.50%;金黄色葡萄球菌对万古霉素及替考拉宁敏感,耐药率均为0;而白色假丝酵母菌对两性霉素B敏感,耐药率为0;研究最终确定急性白血病下呼吸道感染的危险因素为血红蛋白≤50g/L、血小板计数≤30×109/L、预防性使用抗菌药物以及使用糖皮质激素。结论对急性白血病发生下呼吸道感染治疗时可对其危险因素进行干预,感染发生后,应选用敏感抗菌药物进行治疗。
Objective To investigate the distribution and drug resistance of pathogens in lower respiratory tract infection of acute leukemia and to analyze the risk factors of lower respiratory tract infection and provide reference for clinical treatment. Methods 87 hospitalized patients with acute leukemia were selected as research objects, sputum samples were collected for pathogen culture and susceptibility testing; logistic regression analysis of risk factors for lower respiratory tract infection in patients with acute leukemia. Results A total of 40 cases of lower respiratory tract infection occurred. Gram-negative bacteria accounted for 67.21%, Gram-positive bacteria accounted for 24.59% and fungi accounted for 8.20%. The strains were mainly Klebsiella pneumoniae, Escherichia coli, golden yellow grape Cocci, Pseudomonas aeruginosa and Acinetobacter baumannii. The pathogenic bacteria were detected to be resistant to various antibiotics. Klebsiella pneumoniae was sensitive to imipenem and meropenem, and the rates of resistance were 18.75% and 12.50% ; Staphylococcus aureus was sensitive to vancomycin and teicoplanin, the resistance rate was 0; while Candida albicans was sensitive to amphotericin B, the resistance rate was 0; the study finally determined acute leukemia lower respiratory tract infection The risk factors for hemoglobin ≤ 50g / L, platelet count ≤ 30 × 109 / L, prophylactic use of antibiotics and the use of glucocorticoids. Conclusions In the treatment of lower respiratory tract infection of acute leukemia, its risk factors may be intervened. After the infection occurs, sensitive antimicrobial agents should be used for treatment.