论文部分内容阅读
目的探讨急性白血病患者中性粒细胞减少期常规口服喹诺酮类药物预防感染的影响。方法 309例发生感染的急性白血病住院患者,中性粒细胞减少期常规口服喹诺酮类药物预防细菌感染149例(A 组),无喹诺酮预防感染160例(B 组)。回顾性分析两组患者的菌群流行病学特征及敏感性、发生感染的临床特征,研究喹诺酮类药物预防性应用的影响。结果两组患者均存在严重的中性粒细胞减少,中性粒细胞绝对值(ANC)<0.2×10~9/L 持续中位时间为11(0～43)d。中位发热天数为8(1～46)d。喹诺酮类药物的预防应用使正常菌群显著减少(P=0.00),大肠杆菌的比例明显增加(P=0.00),其他主要致病菌的菌群分布无明显区别。喹诺酮预防病区和非喹诺酮预防病区的大肠杆菌超广谱β内酰胺酶(ESBL)阳性率无明显区别(分别为31.9%、35.4%,P=0.61)。两组间大部分抗生素的敏感性没有区别。喹诺酮预防组患者上呼吸道感染/扁桃腺炎的发生率(10.7%)减少,消化道感染相对比例(14.4%)增加。喹诺酮类药物的预防性应用并不能降低败血症的发生率(分别为14.0%、14.7%,P=0.86)。A、B 两组患者的初始经验性抗感染治疗的初步有效率分别为65.8%、60.6%(P=0.35),最终有效率分别为96.0%、91.9%(P=0.14),喹诺酮类药物的预防性应用对抗感染治疗没有负面作用。结论急性白血病中性粒细胞减少患者预防性应用喹诺酮类药物影响菌群分布,正常菌群比例明显减少,而大肠杆菌比例相应增加,其他菌群比例无明显变化。常规的抗生素预防没有增加主要致病菌的耐药性。预防性口服喹诺酮类药物不能减少消化道感染及败血症发生。
Objective To investigate the effect of conventional oral quinolone on the prevention of infection in patients with acute leukemia by neutropenia. Methods One hundred and ninety-nine in-patients with acute leukemia who were infected were enrolled in this study. 149 patients (group A) with conventional oral quinolone antibiotics for prevention of bacterial infection were treated with neutropenia, and 160 patients with quinolone-preventive infection (group B). The epidemiological characteristics and sensitivities of the two groups of patients were retrospectively analyzed. The clinical features of the infections and the preventive effects of quinolones were studied. Results Severe neutropenia was found in both groups. The median absolute neutrophil count (ANC) <0.2 × 10 ~ 9 / L was 11 (0-43) days. Median fever days for the 8 (1 ~ 46) d. Quinolone prophylaxis application significantly reduced the normal flora (P = 0.00), the proportion of Escherichia coli increased significantly (P = 0.00), the distribution of other major pathogens no significant difference. The positive rates of ESBL in the quinolone preventive and non-quinolone preventive wards were similar (31.9%, 35.4%, P = 0.61, respectively). There was no difference in the sensitivity of most antibiotics between the two groups. The incidence of upper respiratory infection / tonsillitis in the quinolone prophylaxis group decreased (10.7%) and the relative proportion of alimentary tract infections (14.4%) increased. The prophylactic use of quinolones did not reduce the incidence of sepsis (14.0%, 14.7%, respectively; P = 0.86). The initial effective rates of initial empirical anti-infective treatment in group A and B were 65.8% and 60.6% (P = 0.35), the final effective rates were 96.0% and 91.9% (P = 0.14) respectively. The effective rates of quinolones Prophylactic use has no negative effect on anti-infective therapy. Conclusions The prophylactic use of quinolones in acute leukemia patients affected the distribution of bacteria, the proportion of normal flora was significantly reduced, but the proportion of E. coli increased correspondingly, while the proportion of other flora did not change significantly. Routine antibiotic prophylaxis does not increase the resistance of the major pathogenic bacteria. Preventive oral quinolones do not reduce gastrointestinal infections and sepsis.