[Clinical Analysis of Bloodstream Infection after Hematopoietic Stem Cell Transplantation]

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Feb;30(1):292-297. doi: 10.19746/j.cnki.issn.1009-2137.2022.01.048.
[Article in Chinese]

Abstract

Objective: To analyze the clinical characteristics of bloodstream infection (BSI) in patients treated by hematopoietic stem cell transplantation (HSCT).

Methods: The clinical characteristics, distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed.

Results: Among 910 HSCT patients, 111 patients were diagnosed as BSI within 100 days after transplantation, and 98 patients showed BSI during the period of agranulocytosis. Multivariate analysis showed that the usage of anti-thymocyte globulin (ATG), long duration of agranulocytosis and low infusion volume of mononuclear cell (MNC) were the independent risk factors affecting BSI after HSCT. Among 121 pathogenic bacteria isolated, 76 Gram-negative (G-) bacteria (62.8%), 40 Gram-positive (G+) bacteria (33.0%), and 5 fungi (4.1%) were detected out. The top three pathogens were Escherichia coli, Staphylococcus epidermidis and Pseudomonas aeruginosa. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3% and 7.7%, respectively, and Pseudomonas aeruginosa was 66.7%. The susceptibility of G+ bacteria to vancomycin, linezolid and teicoplanin was 97.5%, 100% and 100%, respectively. The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI (P<0.001).

Conclusion: The usage of ATG, long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT. The pathogens after HSCT are mainly G- bacteria. Pseudomonas aeruginosa is highly resistant to carbapenems. Key words ;

题目: 造血干细胞移植后血流感染的临床分析.

目的: 分析造血干细胞移植(HSCT)患者血流感染的临床特征.

方法: 回顾性分析2013年1月至2020年6月在我科行HSCT的910例患者的临床特征、发生血流感染的病原菌分布及药敏情况.

结果: 910例患者中,111例在移植后100 d内确诊血流感染,98例的血流感染发生在粒细胞缺乏(粒缺)期。多因素分析显示,预处理方案含抗胸腺细胞球蛋白(ATG)、粒缺持续时间长、单个核细胞(MNC)输注量低是HSCT后血流感染的独立危险因素。分离出的121株病原菌中,革兰氏阴性(G-)菌 76株(62.8%),革兰氏阳性(G+)菌 40株(33.1%),真菌5株(4.1%)。病原菌前3位依次为大肠埃希菌、表皮葡萄球菌和铜绿假单胞菌。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对碳青霉烯类药物耐药率分别为14.3%、7.7%和66.7%。G+菌对万古霉素、利奈唑胺、替考拉宁的敏感率分别为97.5%、100%和100%。血流感染患者HSCT后100 d死亡率显著高于无血流感染患者(P<0.001).

结论: 预处理方案含ATG、粒缺持续时间长、MNC输注量低是HSCT后血流感染的独立危险因素,移植后血流感染病原菌以革兰氏阴性菌多见,铜绿假单胞菌对碳青霉烯类药物耐药率高.

Keywords: bloodstream infection; drug-resistance; hematopoietic stem cell transplantation.

MeSH terms

  • Bacteremia* / epidemiology
  • Bacteria
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Retrospective Studies
  • Sepsis*