【摘要】 目的探讨儿童急性白血病化学治疗后医院感染的危险因素及病原体特点。方法总结分析68例急性白血病患儿接受化学治疗后发生医院感染的相关危险因素、感染部位、病原体检出情况、药敏结果、治疗方法及疾病转归。结果 68例患儿共接受化学治疗617例次,发生医院感染170例次,以呼吸道感染最多见,其次是血液、口腔和泌尿系统等感染。急性淋巴细胞性白血病患儿医院感染例次率26.5%,急性髓性白血病患儿医院感染例次率58.9%。中性粒细胞≤0.5×109/L、血红蛋白≤90 g/L、血小板≤100×109/L、处于诱导化学治疗期的医院感染率升高(P均<0.05)。病原学检查检出病原菌以革兰阳性球菌为主,占50%,总检出率12.4%(21/170);革兰阴性杆菌次之,占40.4%,总检出率10%(17/170)。对革兰阴性杆菌敏感的药物有亚胺培南/西司他丁、阿米卡星、哌拉西林他唑巴坦和环丙沙星,对革兰阳性球菌敏感的药物有万古霉素和利奈唑胺。结论骨髓抑制程度、不同化学治疗阶段与白血病患儿院内感染有关。革兰阳性球菌感染在血液病患儿感染中不可忽视。对于病情严重而无明确感染灶或病原学证据的患儿,经验性治疗应覆盖革兰阳性球菌、革兰阴性杆菌、厌氧菌和真菌。更多还原

【Abstract】 Objective To investigate the risk factors and pathogen characteristics of nosocomial infection in children diagnosed with acute leukemia after chemotherapy. Methods The risk factors, infection site, pathogen detection, drug susceptibility, therapeutic approach and clinical prognosis of 68 acute leukemia children who suffered from nosocomial infection following chemotherapy were retrospectively analyzed. Results Sixty-eight children received 617 cycles of chemotherapy and nosocomial infection occurred after 170 cycles of chemotherapy. The respiratory tract infection was the most frequent symptom, followed by blood, oral cavity and urinary system infections.The infection rate of children with acute lymphoblastic leukemia was 26.5%, and 58.9% in those with acute myeloid leukemia. The nosocomial infection rate was significantly increased when the neutrophil was ≤0.5×10~9/L, hemoglobin was ≤90 g/L, platelet was ≤ 100×10~9/L and in the stage of induced chemotherapy(all P<0.05). The gram-positive cocci accounted for 50% of all pathogens with a total detection rate of 12.4%(21/170). The proportion of gramnegative bacilli was 40.4% with a total detection rate of 10%( 17/170). The gram-negative bacilli were relatively sensitive to imipenem/sistine, amikacin, piperacillin/tazobactam and ciprofloxacin. The gram-positive occi were sensitive to vancomycin and linezolid. Conclusions The degree of bone marrow suppression and different stages of chemotherapy are closely correlated with the risk of nosocomial infection in children with leukemia. Gram-positive cocci infection cannot be ignored for the blood infection in the affected children. For children with severe disease without clear focal infection or etiological evidence, empirical treatment should consider the gram-positive cocci, gramnegative bacilli,anaerobic bacteria and fungi.更多还原