急性白血病患儿医院血流感染的临床及实验室分析

目的分析儿科急性白血病（AL）患儿并发医院血流感染的临床特点及实验室资料，为合理选用抗菌药物，有效控制感染提供依据。方法收集2003年1月-2008年12月住院的AL合并医院血流感染的52位患儿病例，分析其临床表现、病原菌种类及药敏情况。结果临床特点：大多无明确感染病灶；少部分感染部位明确，其中最常见的为皮肤、口腔、肛周及会阴肿痛病灶；病原菌种类：分离出致病菌52株，其中革兰阴性菌（G^-）31例（59．62％），革兰阳性菌（G^＋）12例（23．09％），真菌9例（17．31％）；排在前6位的病原菌依次为铜绿假单胞菌、大肠埃希菌（ECO）、葡萄球菌、真菌、肺炎克雷伯菌、肺炎链球菌；阴沟肠杆菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、屎肠球菌和粪肠球菌未分离到；药敏情况：大肠埃希菌菌和克雷伯菌属超广谱β-内酰胺酶（ESBLs）产生率为72．73％和50％，耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别是67％和60％；未发现耐万古霉素金黄色葡萄球菌（SAU）和凝固酶阴性葡萄球菌（CNS）；G^＋菌对万古霉素、夫西地酸、利奈唑胺、利福平最敏感，G^-菌对亚胺培南、头孢吡肟、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦最敏感。结论我院儿科AL患儿血流感染以G^-菌为主，耐药性明显升高，真菌感染比例升高；大多病情凶险，应根据细菌分布及耐药特点，有针对性地选择抗生素，降低感染死亡率；经验性抗菌治疗可选亚胺培南、头孢吡肟、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、万古霉素、夫西地酸、利奈唑胺、利福平。

Clinical and laboratory studies on hospital-acquired bloodstream infection in childhood acute leukemia

Aim To investigate the clinical feature and laboratory results of hospital-acquired bloodstream infection in childhood acute leukemia, so as to provide reference for the rational use of antimicrobial agent. Method Clinical data of 52 cases of hospital - acquired bloodstream infection in childhood acute leukemia from January 2003 to December 2008 were analyzed, the clinical manifestations and types and antimicrobial susceptibility results of pathogens isolated from bloodstream were analysed. Result Clinical characteristics were as follows ： the most was no definite infection sites, there had red lump and pain at skin and oral and perianal and perineum; A total of 52 organisms were collected in the survey period, which included 31 （59.62%）Gram-negativ strains, 12（23.09% ） Gram-positive strains and 9 （ 17.31% ） Fungal strains ; Pseudontonas aeruginosa, Escherichia coli, Staphylococcus , Fungi, Klebsiella pneumonia, streptococcus pneumoniae were the most common isolates ; there were no enterobacter cloacae, Acinetobaeter baumannii, Stenotrophomonas maltophilia , Enteroeoccus faecium, Enterococcus faecalis; About 72.73% Eseherichia coli and 50% Klebsiella pneumonia isolates were ESBLs- producing strains. 67% and 60% of S. aureus and CNS were meticillin-resistant, respectively;No Staphylococcus strain and CNS were resistant to vancomycin; Gram-positive bacteria were susceptible to Vaneomyein, FusidicAeid, linezolid and rifampicin, Gram-negative bacteria were susceptible to imipenem, cefepime, cefoperazone/sulbactam, piperacillin/tazobactam. Conclusion Gram-negative bacteria are the most common organisms in childhood acute leukemia , bacterial resistance is severe , and the resistant rates are increasing, and the fungal infection rates are increasing; clinical manifestations are emergent and serious, antimicrobial agents should be rationally selected for the initial empiric treatment, referring to the bacterial distribution and resistance, Imipenem, cefepime, cefoperazone/sulbactam, piperaeillin/tazobactam, vancomycin, fusidieAeid , linezolid and rifampicin can be chosen as empiric antimicrobial agents for treatment of infection.