Clinical And Etiological Characteristics And Prognostic Factors Of Patients With Hematological Malignancies Complicated With Bloodstream Infection

Objective:To analyze the clinical and etiological features and prognostic factors of patients with hematological malignancies complicated by bloodstream infection in the Department of Hematology of our hospital.Methods:A total of 185 cases of hematological malignancies with positive blood culture and confirmed bloodstream infection were included.Taking 30 days after the first positive blood culture as the observation end point,the collected cases were divided into survival group and death group.I collected relevant clinical indicators for analysis,including age,gender,length of length of stay,type of primary of clinical manifestations,pathogens and drug sensitivity analysis,routine blood results before the first blood culture,duration of neutropenia,degree of neutropenia,degree of thrombocytopenia,plasma albumin,antibiotic usage,whether there was invasive operation,whether there was diabetes,cardiac insufficiency,renal insufficiency,etc.SPSS18.0 statistical software was used to organize and analyze the collected data.Univariate analysis was performed using chi-square test,and multivariate analysis was performed using unconditional Logistic regression analysis.Results:A total of 185 patients with hematological malignancies combined with bloodstream infection were collected.Among them,there were 150 cases in the survival group and 35 cases in the death group.The top three malignant hematological diseases were 98 cases of acute myeloid leukemia(52.97%),32 cases of lymphoma(17.30%),and 27 cases of acute lymphoblastic leukemia(14.59%).There were 171 cases of moderate fever(92%)and 14 cases of low fever(8%).Respiratory tract infection was the most common infection(51.89%),followed by gastrointestinal infection(11.35%)and perianal infection(7.03%),but no clear infection was found in63 cases(34.05%).A total of 197 pathogenic bacteria were cultured in blood samples from 185 patients with bloodstream infection(11 cases were infected with two or more pathogenic bacteria),of which 109 were Gram-negative bacteria(55.33%)and86 were Gram-positive bacteria.(43.65%),2 strains of fungi(1.02%).Gram-negative bacteria were mainly Escherichia coli(55 strains,27.92%),Klebsiella pneumoniae(20strains,10.15%),and Pseudomonas aeruginosa(15 strains,7.61%).Gram-positive bacteria were mainly Staphylococcus hominis(24 strains,12.18%),Staphylococcus epidermidis(21 strains,10.66%),and Staphylococcus aureus(11 strains,5.58%).The results of univariate analysis showed that the survival group and the death group were significantly different in age(P=0.045),empirical use of antibiotics(P=0.036),duration of neutropenia(P<0.001),and whether there was pulmonary infection(P=0.003),cardiac insufficiency(P<0.001),renal insufficiency(P<0.001),and septic shock(P<0.001).Logistic analysis showed that the duration of agranulocytosis ≥7days(OR=3.306),cardiac insufficiency(OR=6.291),renal insufficiency(OR=8.419),septic shock(OR=22.150)were Independent risk factors for death within30 days in patients with bloodstream infection in the Department of Hematology of our hospital.Conclusion:1.The distribution of pathogenic bacteria in patients with hematological malign-ancies and bloodstream infection in the Department of Hematology in our hospital is dominated by gram-negative bacteria;The main pathogenic bacteria are Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Staphylo-coccus.2.Agranulocytosis lasting longer than 7 days,patients with cardiac insufficiency,renal insufficiency and septic shock were independent risk factors for death within 30 days of bloodstream infection in the Department of Hematology of our hospital.