| Backgrounds and ObjectiveAntimicrobial agent is the most widely used drug in medical practice. To standardize the use of antibiotics is very important to the prevention of drug abuse, microbial resistance and duplex infection in hospital. Because of the diseases status and the use of immunsuppressive agents and chemotherapeutic drugs, patients' immunity is extremely impaired, exposing the patients vulnerable to the invasion of pathogens. Infection is a common complication and leading causes of death of patients with hematological disorders. Fever is the most common clinical manifestation of infection. There are neutropenia or agranulocytosis in most hematological disorders with fever. As a result, it is necessary to treat the patients promptly in order to prevent the development of sepsis or infectious shock. With the discovery and development of antibiotics, the use of new anti-microbial agents is getting attention. Currently, a guide of antibiotics in hematological diseases with fever has not been set up. There were a few reports on the use of antimicrobial drugs in the treatment of hematological diseases with fever. In order to analyse the current uses of antibiotics in with hematological disorders companied with fever and provide a bases for future use of antibiotics, this paper analyzed the clinical data and the use of antibiotics in patients with hematological disorders companied with fever. The results were compared with issued by this hospital.Clinical data and analysis methods1. Clinical data: 108 cases of hematological diseases with fever were treated in the Department of Hematology of the First Affiliated Hospital of Zhengzhou University from September 1 ,2005 to December 15, 2005. These patients have a mean age of 42.75 years old (aged from 15 to 75 years old) with 56 males and 52 females.2. data collection: Batch analysis was employed on tall cases, focused on the category, frequency and cultures of pathogen. The general data and original diseases of patients, it's the degree of fever, the antibiotics given to patients and their general names, specification, dosage, dircetion, use period, administration route, total drug dosage, total medical costs with fraction of antibiotics.3. Statistical methods: The results were analyzed using software EXCEL for data processing, combined with the overall administration of our hospital and hospital issued comprehensive analysis.Result:1. Patients' clinical data: All 108 patients were hospitalized for 1-78 days. hospitalization costs (￥6730.00±347.781)Yuan with antibacterial drug at (￥1675.48±287.54)Yuan.All patients had varying degrees of fever with 16 cases in 37.3℃-37.9℃, 45 cases in 38.0℃-38.9℃, 43 cases in 39.0℃-40.9℃, 4 cases in 40.9℃higher , The WBC when patients had fever were as followings 11 cases in 0.5×10~9/L, 36 cases in (0.5-4.0)×10~9/L 27 cases in (4.0-10)×10~9/L , 34 cases in > 10×10~9/L . Disease diagnosis: acute myeloid leukemia in 22 patients, acute lymphoblastic leukemia in 20 cases, chronic myelogenous leukemia in 5 cases, myelodysplastic syndrome in 17 cases, aplastic anemia in 17 cases, Non-Hodgkin's lymphoma in 4 cases, chronic lymphocytic leukemia in 4 cases, multiple myeloma 19. All patients diagnosed with bone marrow cytology, histochemistry and immunohistochemical study. Eighty-five cases were diagnosed as leukemia, lymphoma and myeloma, with 42 patients receiving induction chemotherapy and 43 patients given consolidation treatment.2. Examination of pathogens: Thirty-nine out of 108 (36.1%) patients were examined for pathogens.Samples for bacteria culture were collected frogmouth and throat, and sputum secretion (22 cases) ; blood and bone marrow (9 cases) ; skin, perianal abscess(4 cases);and faeces(4 cases. Total 25 stains of bacteria (64.1%) were grown, with strain and occurrence as following: Klebsiella pneumoniae (9), Pseudomonas aeruginosa (7), S.albicans (4), Staphylococcus aureus (2), Candida albicans (1), E. coli (1) and Shaped citrobacter (1).3. Analysis on the combining use of antibiotics: The antibiotics used in this paper covered nine categories of 31 antimicrobial agents, the majority of which were used in combination with two agents combination at 37.17% and triple combination at 40.7%. In terms of the degree of fever, 16 cases with low fever were treated withsingle agent (8 cases), two agents combination (6 cases) and triple-combination (2 cases). Fourty-five cases with medium fever were treated with two agents combination (35 cases), triple-(5 cases) and tetra-combination (5 cases). Forty-three cases with high fever were treated with two agents combination (3 cases), triple-(32 cases) and tetra-combination (8 cases). Four cases with super-high fever were treated with triple-(1 case), tetra- (1 case) and pento- combination (2 cases).4. The frequency of antibiotics used: The antibiotics used were sequenced aspiperacillin, levofloxacin, cefoperazone, imipenem, metronidazole, flucanozol, demethylvancomycin, etc.Conclusion:1. The use of antibiotics in teatment of hematological disorders with fever are dominated by multiple agents combination as pathogen-specific anergic state are a common issue in these patients. three generations of cephalosporins drugs are the most commonly used antibiotics at our hospital patients with hematological fever, followed by the use of high frequency quinolones, aminoglycosides, the second generation cephalosporins, and other.2. Klebsiella pneumonia is becoming the most common pathogen isolated from patients with hematological disorders companied with fever. Attention should be paid to invasive systemic fungi infection and the adequate use of anti-fungous agent.3. It is reasonable and proper for the use of antibiotcs in the department of hematology to treat patients with hematological disorders companied with fever. However, screening of pathogen should be done on most cases in order to guide the proper clinical use of antibiotics.
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