血液肿瘤患者并发感染的病原学分布及影响因素分析OA
Analysis of the etiological distribution and influencing factors of infections in patients with hematologic malignancies
目的 探究血液肿瘤患者并发感染的特点、病原菌分布及治疗现状,并对感染发生的影响因素进行分析.方法 采用回顾性研究方法,选取2023年1月至2024年12月在我院接受抗肿瘤治疗且发生感染的血液肿瘤患者,作为感染组;采用1∶1倾向性评分匹配的方法选取相同数量的未并发感染的血液肿瘤患者作为对照组.通过单因素分析年龄、感染预防措施、合并基础疾病、静脉置管、血液肿瘤类型、既往真菌感染、造血干细胞移植、入住重症监护病房史、接受肠外营养、中性粒细胞水平、免疫球蛋白水平及CD4+T细胞水平等因素对患者感染发生的影响.将上述结果中P＜0.1的变量纳入logistic回归模型进行多因素分析,筛选感染发生的独立影响因素.结果 共纳入180例血液肿瘤患者.单因素分析显示,年龄、血液肿瘤类型、是否预防感染、造血干细胞移植、肠外营养、中性粒细胞水平、免疫球蛋白水平与感染发生相关(P＜0.05).Logistic回归分析显示患者罹患白血病(OR=4.851,95％CI:1.211～19.432,P=0.026)及CD4+T细胞水平偏低(OR=4.471,95％CI:1.209～16.535,P=0.025)是感染的危险因素,而未进行造血干细胞移植(OR=0.040,95％CI:0.006～0.255,P=0.001)则为保护因素.结论 血液肿瘤患者并发感染以革兰阴性菌(如肺炎克雷伯菌及大肠埃希菌)导致的肺部感染为主,治疗常用β-内酰胺类药物;白血病与低CD4+T细胞水平是主要危险因素,未行造血干细胞移植则为保护因素.
AIM To investigate the characteristics of infections,distribution of pathogenic bacteria,and current treatment status in patients with hematological malignancies,and analyze the influencing factors for infection occurrence.METHODS A retrospective study was conducted in which patients with hematologic malignancies who received anticancer treatment at our hospital between January 2023 and December 2024 and subsequently developed an infection were selected to form the infection group.Using a 1∶1 propensity score matching method,an equal number of non-infected patients were selected as the control group.Univariate analysis was used to compare factors such as age,infection prophylaxis,comorbidities,intravenous catheterization,type of hematological malignancies,history of fungal infection,hematopoietic stem cell transplantation,ICU admission,parenteral nutrition,neutrophil level,immunoglobulin level,and CD4+T cell level for their impact on infection occurrence.Variables with P＜0.1 from the above results were included in a logistic regression model for multivariate analysis to identify the independent risk factors for infection.RESULTS A total of 180 patients with hematological malignancies were included.Univariate analysis showed that age,type of hematological malignancies infection prophylaxis,hematopoietic stem cell transplantation,parenteral nutrition,neutrophil level,and immunoglobulin level were associated with infection.Logistic regression analysis revealed that patients with leukemia(OR=4.851,95％CI:1.211-19.432,P=0.026)and low CD4+T cell levels(OR=4.471,95％CI:1.209-16.535,P=0.025)were risk factors for infection,while not undergoing hematopoietic stem cell transplantation(OR=0.040,95％CI:0.006-0.255,P=0.001)served as a protective factor.CONCLUSION Infections in patients with hematologic malignancies primarily manifest as pulmonary infections caused by Gram-negative bacteria(such as Klebsiella pneumoniae and Escherichia coli),which are typically treated with β-lactam antibiotics;leukemia and low CD4+T cell counts are the main risk factors,while the absence of hematopoietic stem cell transplantation is a protective factor.
武卓;涂好;冯思敏;叶林萱;丁天凌;王斌
复旦大学附属华山医院药剂科,上海 200040复旦大学附属华山医院药剂科,上海 200040上海健康医学院药学院,上海 201318复旦大学附属华山医院药剂科,上海 200040||深圳市第二人民医院药剂科,深圳 518032复旦大学附属华山医院血液科,上海 200040复旦大学附属华山医院药剂科,上海 200040
医药卫生
血液肿瘤感染影响因素
hematologic malignanciesinfectioninfluencing factor
《中国临床药学杂志》 2026 (6)
518-523,6
上海市卫健委卫生行业临床研究专项(编号202040424)上海市"医苑新星"青年医学人才培养资助计划-临床药师项目资助(编号:沪卫人事[2021]99号)
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