Analysis of Risk Factors and Clinical Indicators in Bloodstream Infections Among Patients with Hematological Malignancy.
Analysis of Risk Factors and Clinical Indicators in Bloodstream Infections Among Patients with Hematological Malignancy.
复制标题
血液恶性肿瘤患者血流感染危险因素及临床指标分析
DOI：
10.2147/cmar.s289291
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发表时间：
2020
影响因子：
3.3
通讯作者：
Wang C
中科院分区：
文献类型：
--
作者：
Ma Y;Wang S;Yang M;Bao J;Wang C
血液系统恶性肿瘤患者的血流感染（BSI）发生率较高。区分感染性发作和非感染性发作是很重要的。本研究旨在描述恶性血液病患者院内血流感染的流行病学、临床指标和抗生素使用情况。对我院2015年7月至2018年3月收治的血液系统恶性肿瘤患者进行单中心回顾性研究。收集了322例发热患者的实验室和临床资料。根据血培养结果分为两组：1）血培养阳性组，2）血培养阴性组。322例发热患者血培养阳性81例（25.2%），其中革兰阴性菌（51.9%）多于革兰阳性菌（32.1%）和真菌（7.4%）。革兰阴性菌比G+菌更易产生耐药性。独立危险因素显示，患者并发症，高水平的降钙素原（PCT），血糖，白细胞介素-6（IL-6），D-二聚体（D-D）和低浓度的白蛋白与BSI的发生相关。PCT、IL-6、D-D对阳性组与阴性组的鉴别诊断有较好的作用。此外，IL-6和D-D在区分G-和G+组方面表现出优异的性能，曲线下面积均大于0.8。我们分析了血液系统恶性肿瘤患者BSI的危险因素、细菌分布、抗生素耐药性以及临床参数的变化。这项单中心回顾性研究可能为临床医生提供BSI诊断和治疗的见解。
The incidence of bloodstream infection (BSI) is more common in patients with hematological malignancy. It is important to distinguish infectious episodes from noninfectious episodes. The present study was aimed to describe the epidemiology, clinical indexes, and antibiotic use for in-hospital bloodstream infections of hematological malignancy patients. Single-center retrospective research was performed on hematological malignancy patients admitted to our hospital from July 2015 to March 2018. Laboratory and clinical information from 322 febrile patients were acquired. These episodes were divided by blood culture results into two groups: 1) blood culture positive-group, 2) blood culture negative-group. In the 322 febrile cases, 81 (25.2%) patients were blood culture positive, and among them, Gram-negative (G-) bacteria (51.9%) were more isolated than Gram-positive (G+) bacteria (32.1%) and fungi (7.4%). Gram-negative bacteria were more likely to have drug resistance than G+ bacteria. Independent risk factors revealed that patients with complications, high levels of procalcitonin (PCT), glucose, interleukin-6 (IL-6), and d-dimer (D-D), and low concentration of albumin were correlated with the occurrence of BSI. PCT, IL-6 and D-D performed well in differentiating the positive group from the negative group. Moreover, IL-6 and D-D showed excellent performance in differentiating G- and G+ groups, with the areas under the curve all above 0.8. We analyzed the risk factors for BSI in patients with hematological malignancy, the distribution of bacteria, antibiotic resistance, and the changes in clinical parameters. This single-center retrospective study may provide clinicians insight into the diagnosis and treatment of BSI.