Objectives: To analyze the pathogenic distribution, antibiotic susceptibility and prognostic factors for acute leukemia (AL) patients with Gram negative (G-) bacterial bloodstream infection (BSI), in order to provide theoretical basis for reducing the infection-related mortality of AL patients.
Methods: The clinical data of 1 055 AL patients with BSI admitted to the hematology ward of three large-scale hospitals in Hunan Province from January 2010 to December 2018 were collected. The etiology, antibiotic susceptibility data and clinical features of patients with G- bacterial infection were analyzed.
Results: G- bacterial infection accounted for 622 AL patients with BSI, and the main pathogens were Escherichia coli (277 strains, 44.53%), Klebsiella pneumoniae (138 strains, 22.19%), and Pseudomonas aeruginosa (81 strains, 13.02%). Most G- bacteria were highly sensitive to carbapenems and β-lactam/β-lactamase inhibitor. State of disease, Pitt score ≥4, treatment with vasoactive agents and sensitive antibiotic >48 h were independent risk factors of 30-day mortality.
Conclusions: Rational antibacterial treatment of G- bacterial BSI in AL patients requires adequate acquaintance of the local pathogenic epidemiology and antibiotic susceptibility-monitored data. Broad-spectrum antibiotics covering the most common and more virulent pathogens should be timely applicated and adjusted according to antibiotic susceptibility results and efficacy.
目的: 分析急性白血病(acute leukemia，AL)患者合并革兰氏阴性菌(Gram negative bacterium，G-菌)血流感染的病原学分布、药敏特征及预后，为降低AL患者感染相关病死率提供依据。方法: 收集2010年1月至2018年12月湖南省三家大型医院血液科1 055例合并血流感染的AL患者的临床资料，并对其中G-菌感染患者的病原学、药敏数据及临床特征进行分析。结果: 622例合并血流感染的AL患者为G-菌感染，主要致病菌为大肠埃希菌(277株，44.53%)、肺炎克雷伯菌(138株，22.19%)、铜绿假单胞菌(81株，13.02%)。多数G-菌对碳青霉烯类药物及β内酰胺/β内酰胺酶抑制剂敏感率较高。疾病状态、Pitt菌血症评分≥4、使用血管活性药物、启动敏感抗菌药物治疗时间>48 h是AL患者合并G-菌血流感染30 d内死亡的独立危险因素(P<0.05)。结论: AL患者合并G-菌血流感染的合理抗菌治疗需充分了解当地病原菌流行病学及药敏监测数据，及时应用覆盖最常见和毒力较强病原菌的广谱抗菌药物，并根据药敏结果及疗效调整用药。.
Keywords: Gram negative bacterium; acute leukemia; antibiotic susceptibility; bloodstream infection; etiology; prognostic factor.