Clinical Study Of Nosocomial Infection In Patients With Malignant Hematopathy

Purpose: To understand the clinical features of hospitalized infection in patients with hematologic malignancies,and to summarize the types and drug resistance of common pathogens,and to provide evidence for clinical prevention and treatment of patients with hematologic malignancies.Methods:A retrospective analysis was performed on patients with hematologic malignancies who were hospitalized for more than 48 hours from January 2015 to June 2018 in the Department of Hematology,Tianjin Fourth Central Hospital.The patients with nosocomial infections were recorded for their gender,age,underlying disease,and starting.Symptoms,infection sites,pathogenic bacteria and drug susceptibility results,etc.,analysis of the incidence of hospital infections,risk factors,common infection sites,first symptoms and common pathogens and drug resistance.The data were analyzed by statistical software SPSS19.0.The chi-square test was used to compare the single factor rate.P<0.05 was considered statistically significant.Result:1.A total of 981 patients with hematologic malignancies who met the enrollment conditions,260 cases of nosocomial infection,the total infection rate was 26.5%,including 401 cases of acute leukemia,132 cases of nosocomial infection,the infection rate was 32.9%,significantly higher than In patients with other hematological malignancies,the P <0.05.2.age ≥ 60 years old,hospital days ≥ 30 d,neutrophil number ≤ 0.5 *10^9 / L,receiving chemotherapy,primary disease is not relieved,etc.is a risk factor for nosocomial infection in patients with hematologic malignancies.3,respiratory tract is the most common infection site of nosocomial infection,260 patients with nosocomial infection have respiratory tract infection in 161 cases,urinary tract infection in 33 cases,bloodstream infection in 26 cases,skin and soft tissue infection in 18 cases,and infection site unknown in 22 cases.4.Of the 260 hospital-infected patients,150 had fever as the first symptom,71 had cough and cough as the first symptom,21 had urinary frequency and dysuria as the first symptom,and 18 had other symptoms.5.260 hospital infection patients,227 cases of bacterial infection,14 cases of bacterial fungal infection,19 cases of simple fungal infection.Among them,145 cases obtained pathogenic data and 167 pathogenic bacteria were detected.125 strains of Gram-negative bacteria,accounting for 74.8 %,mainly Escherichia coli,Klebsiella pneumoniae,Stenotrophomonas maltophilia,Pseudomonas aeruginosa,Acinetobacter baumannii;Gram-positive bacteria 24 strains,accounting for 14.4%,mainly Staphylococcus aureus,Enterococcus faecium.6.Drug sensitivity analysis showed that in the Gram-negative bacilli,in addition to ampicillin,ESBLs(-)Escherichia coli and Klebsiella pneumoniae were sensitive to most antibacterial drugs,while ESBLs(+)Escherichia coli Resistance to bacteria and Klebsiella pneumoniae increased significantly;Stenotrophomonas maltophilia was sensitive to cefoperazone/sulbactam,ticarcillin/clavulanic acid,quinolones and tetracyclines.7.Drug sensitivity analysis showed that among Gram-positive bacteria,common Staphylococcus aureus had only high resistance rate to penicillin,while MRSA was resistant to oxacillin,and the resistance rate to other antibiotics was common.Staphylococcus aureus is similar;in addition to linezolid,vancomycin,and tigecycline,Enterococcus faecium is resistant to most antimicrobial agents.Conclusion:1.The incidence of nosocomial infection in patients with hematologic malignancies is significantly higher.Patients with acute leukemia are higher than patients with non-acute leukemia,and patients with chemotherapy are higher than those without chemotherapy.2.The risk factors for nosocomial infection in patients with hematologic malignancies include advanced age,long-term hospitalization,neutropenia,chemotherapy,and primary disease.The location of nosocomial infections is mainly respiratory tract,followed by urinary system,blood flow,and skin soft tissue.3.The pathogenic bacteria in hospitalized patients with malignant hematological diseases are mainly Gram-negative bacteria.4.ESBLs(-)Escherichia coli and Klebsiella pneumoniae are sensitive to other commonly used antibiotics,in addition to the increased resistance to ampicillin.ESBLs(+)Escherichia coli is resistant to quinolones and is sensitive to fourth-generation cephalosporins,whereas ESBLs(+)Klebsiella pneumoniae,in contrast,has resistance rates to other commonly used antibiotics.similar.