【摘要】 目的了解自体外周血干细胞移植患者的院内感染情况,为预防和指导临床用药提供依据。方法回顾性分析2007年1～12月在遵义医学院附属医院行自体外周血干细胞移植的28例患者的临床资料,主要分析移植过程中从预处理至骨髓造血重建期间医院感染的发生、处理及转归情况。结果 28例移植患者共发生60例次感染,47例次(78.3%)发生在骨髓抑制期粒细胞缺乏时;其中脓毒血症20例次(33.3%);口腔溃疡伴感染10例次(16.7%);口唇疱疹病毒感染3例次(5.0%);上呼吸道感染11例次(18.3%);肺部感染3例次(5.0%);胃肠道感染6例次(10.0%);肛周感染7例次(11.7%);20例患者为多部位感染,感染部位同时累及血液、口腔、上呼吸道、肛周较多见;对体温>38.5℃的20例患者连续三次抽取血培养+药敏试验,6例血培养结果阳性,其阳性率为30%;4例为大肠埃希菌,2例为铜绿假单胞菌,药敏结果分析对碳青霉稀类、β-内酰胺酶抑制剂、氨基糖苷类最敏感,其次为第三代喹诺酮类、第四代及三代头孢菌素类;所有发生医院感染患者据经验及药敏选用抗生素治疗后均治愈,无一例感染相关死亡。结论自体外周血干细胞移植医院感染大多发生于粒细胞缺乏期;医院感染好发部位依次为血液、呼吸道、口腔、肛周、胃肠道;多部位感染常同时累及血液、口腔、上呼吸道及肛周;脓毒血症中以大肠埃希菌最为常见,感染的细菌对碳青霉稀类、β-内酰胺酶抑制剂、氨基糖苷类最敏感。更多还原

【Abstract】 Objective To understand the nosocomial infection following autologous peripheral blood stem cell transplantation in the Affiliated Hospital of Zunyi Medical College, and to provide evidence for guiding its clinical medication. Methods The clinical data of 28 patients with autologous peripheral blood stem cell transplantation from January 2007 to December 2017 in the Affiliated Hospital of Zunyi Medical College were retrospectively analyzed mainly to understand the occurrence and treatment of nosocomial infection during pre-treatment to bone marrow hematopoietic reconstitution during transplantation. Results In 28 cases of transplant patients, a total of 60 infections occurred, and 47 cases(78.3%) occurred in the absence of neutrophils during myelosuppression. There were 20 cases of sepsis(33.3%);10 cases of oral ulcers with infection(16.7%), 3 cases of herpes simplex virus infection(5.0%), 11 cases of upper respiratory tract infection(18.3%), 3 cases of pulmonary infection(5.0%), 6 cases of gastrointestinal infection(10.0%), and 7 cases of perianal infection(11.7%). Twenty cases were multi-site infection, and the infection site involved blood, mouth,upper respiratory tract and perianal more common. The 20 patients with body temperature >38.5℃ took blood three times in succession for culture+drug susceptibility test, and 6 cases of blood culture results were positive, with the positive rate of 30%; 4 cases were Escherichia coli, and 2 cases were Pseudomonas aeruginosa, which were most sensitive to carbapenem and β-lactamase inhibitors and aminoglycosides, followed by the third-generation quinolones, the fourth-generation and third-generation cephalosporins. All patients with nosocomial infections were cured according to experience and drug sensitivity, and there were no infection-related death. Conclusion Most of the autologous peripheral blood stem cell transplantation hospital infections occur in the period of neutropenia. The most common sites of nosocomial infection are blood, respiratory, oral, perianal, and gastrointestinal tract. Multiple infections often involve blood,oral cavity, upper respiratory tract and perianal. Escherichia coli is the most common in sepsis, and the infected bacteria are most sensitive to carbapenem, β-lactamase inhibitors, aminoglycosides.更多还原