| BackgroundThe normal immune function couldn’t perform because of malignant proliferation of tumor cells in the body of patients with hematologic malignancies. Its phagocytosis and chemotaxis were significantly lower than normal cells, and the immunity in patients decreased, which lead such people to be the high risk crowd infected in hospitals (referred to as nosocomial infections). Chemotherapy is the main method of treatment for hematologic malignancies. Chemotherapy drugs include immunosuppressive agents, hormones, cytotoxic drugs and so on. Cytotoxic drugs not only can kill abnormal leukemia cells, but also kill normal blood cells.The application of cytotoxic drugs at a higher dose, which result in severe bone marrow suppression, reduced peripheral blood cells, or even lack of neutropenia, weakened immunity, infection more likely. Especially Invasive fungal infections in patients have severe life-threatening. Therefore, how to prevent and control infection is an important issue faced Hematologists in the course of treatment.ObjectiveTo investigate the infection rate, the site of infection, pathogen distribution, drug resistance of pathogenic bacteria and infection risk factors in patients with hematologic malignancies after chemotherapy.MethodsA retrospective analysis of 485 cases patients with hematologic malignancies from January 2013 to June 2014, the First Affiliated Hospital of Xinxiang Medical College. The data of infection rate, site of infection, pathogen distribution, pathogen resistance and the risk factors of infection in nosocomial infections after chemotherapy are input to statistical analysis.Results1. There were 223 cases of nosocomial infections in the 485 cases patients, in which the infection rate was 45.98%.The cases were divided according to the site of infection:98 cases of respiratory tract infections (43.95%),31 cases of unknown site infections (13.90%),24 cases of bloodstream infections (10.76%),21 cases of perianal infections (9.42%),17cases of oral infections (7.62%),13 cases of urinary tract infections (5.83%),7 cases of gastrointestinal infections (3.14%),6 cases of skin infections (2.70%),4 cases of multi-site infections (1.80%),2 cases of soft tissue infections (0.90%).The strains were divided according to the distribution points of pathogenic microorganisms.121 strains were cultured from 91 cases patients with etiology positive. 65 stains of Gram-negative (Gram-negative bacteria, G-) bacteria account for 53.72%, which include 26 strains Escherichia coli (21.49%), both Klebsiella and Stenotrophomonas maltophilia were 6 strains (4.96%),5 strains of Enterobacter cloacae (4.13%),4 stains of Pseudomonas aeruginosa (3.31%), both moderate Aeromonas and Acinetobacter baumannii were 3 strains (2.48%), radioactive rhizobia, Serratia marcescens were 2 strains (1.65%), the other 8 strais (6.61%); 45 strains of Gram-positive (Gram-positive bacteria, G+) bacteria account for 37.19%, which include 24 strains of Staphylococcus (19.83%),8 strains of Streptococcus (6.61%),5 strains of Enterococcus faecalis (4.13%), both Corynebacterium and Micrococcus were 2 strains(1.65%), the other 4 stains(3.31%); 8 strains of fungus account for 6.61%, in which 5 strains of Candida albicans (4.13%),2 strains of Candida guilliermondii (1.65%), the other 1 strain(O.83%); 3 cases of virus infection account for 2.48%, in which 2 cases of herpes simplex virus (1.65%),1 case of cytomegalovirus (0.83%).2. The resistance analysis of bacterial and fungal.The resistance of G bacteria for piperacillin and sulfamethoxazole was higher; The resistance of G+bacteria for penicillin and amoxicillin/clavulanate potassium was higher. The resistance of fungi for fluconazole and itraconazole was higher.3. Analysis of risk factors.The results of univariate analysis showed that gender had no correlation with nosocomial infection (P>0.05). There were some risk factors for nosocomial infection such as non-remission of the primary disease, old aging, long-stay in hospitanl, reduction of the number of granulocytes, the decreased number of lymphocytes, the reduced number of platelets, decreased hemoglobin, the low content of albumin, long-term use of steroids and the presence of underlying disease (diabetes, chronic obstructive pulmonary disease) (P<0.05); the results in logistic regression analysis of risk factors for nosocomial infection showed that decreased granulocytes, the primary disease-free relief, long hospital stay were high risk factors (P<0.05),Conclusion1. Reduction of the number of granulocytes, the primary disease-free relief, long-stay in hospital are the highest risk factors in patients with hematological malignancies.2. The respiratory infection is the main location in nosocomial infection of patients with hematological malignancies, G-bacteria is the primary pathogenic microorganism for nosocomial infection. |
PDF Full Text Request