A Clinical Analysis Of Malignant Hematology With Bloodstream Infection

Objective To study the characteristics,treatment and prognosis with malignant hematology bloodstream infection in the patients.Methods Collected from March 2013 to December 2015 in our hospital in the treatment of 603 cases of malignant hematologic disease patients do not repeat,70 consecutive isolates of pathogens,analysis of a variety of antibiotics in these malignant blood disease sensitivity and resistance rate,and The infection-related factors,infection sites and prognosis of 60 patients with hematological malignancies with blood flow infection were analyzed.Results 60 strains of malignant hematologic malignancies were selected and 70 strains were cultured.The main pathogens were 16 strains(22.86%)of Escherichia coli,12(17.14%)of Streptococcus pneumoniae,(14.29),Staphylococcus aureus 5(7.14%),Pseudomonas aeruginosa(5.71%),Candida albicans 4(5.71%).The detection rate of ESBLs-producing Klebs was 33.33%,and the detection rate of ESBLs-producing Escherichia coli was 56.25%.All ESBLs-producing Escherichia coli are sensitive to carbapenem antibiotics,but resistant to tobramycin,quinolones and gentamicin and aminoglycosides are resistant to more than 50%,Especially for cefepime,ceftazidime,cefazolin,cefotaxime,its resistance rate as high as 100%.Klebsiella pneumoniae,antibiotic susceptibility to aminoglycosides> 60%,sensitivity to quinolones antibiotics> 70%,sensitivity to imipenem 100%,sensitivity to third and fourth generation cephalosporins Higher than the first generation and second generation(>60%),the sensitivity of the enzyme plus penicillin antibiotics was about 50%,significantly higher than ampicillin(10.5%).Four strains of Pseudomonas aeruginosa were isolated and four strains of Pseudomonas aeruginosa were sensitive to imipenem / cilastatin,levofloxacin and ciprofloxacin.Staphylococcus aureus subspecies,Staphylococcus epidermidis,Staphylococcus aureus on linezolid and vancomycin sensitivity,can reach 100%.Staphylococcus aureus subspecies on methicillin resistance rate of 90.80%,and for Staphylococcus epidermidis and Staphylococcus aureus,their methicillin resistance rates were 38%,75%.In this study,a total of 11 cases of fungal infection,accounting for 15.7%,of which 4 Candida albicans,Candida glabrata 3,Cryptococcus and Mucor bacteria in 1 case,Aspergillus 2 strains,of which there is a case of Candida glabra Oxazole,voriconazole,itraconazole three are resistant.Respiratory infections are most common in infected lesions associated with bloodstream infection.Among the 60 patients,the number of neutrophils> 0.5 * 10 ^ 9 / L and the number of neutrophils <0.5 * 10 ^ 9 / L,the difference was statistically significant(P = 0.02)?.Patient hospitalization time greater than 20 days compared with less than 20 days,the occurrence of multiple infection differences were statistically significant(P value of 0.02).If the actual result of obtaining blood culture before the empirical antibiotic treatment,and the use of antibiotics in the correct group,the average application of antimicrobial drugs 16.01 ± 8.91 days,the incorrect group in the results obtained after the use of sensitive drugs,antimicrobial drugs on average 26.02 ± 12.76 days,the two were statistically significant(P = 0.021),the difference between the two groups of patients with mortality,statistically significant(P value of 0.036).Patients with age> 60 years of age compared with patients with age <60 years of age,the difference in the occurrence of multiple infection and mortality caused by infection was statistically significant in the two groups(P value of 0.043).Conclusion According to statistics,the blood flow of malignant hematologic disease,the pathogen is still mainly Escherichia coli,Klebsiella pneumoniae,Staphylococcus epidermidis,as well as Pseudomonas aeruginosa and Candida albicans mainly,and mainly to leather L-negative bacteria G-based.For the Gram-positive G + bacteria,the most sensitive drugs were linezolid and vancomycin;and Gram-negative G-bacteria,the most sensitive drugs are imipenem and vancomycin.Granulocyte deficiency and hospitalization time were the independent risk factors of hematologic malignancy complicated by blood flow infection.In elderly patients with hematological malignancies,the mortality rate caused by infection is more pronounced.Early use of the right antibiotics to control the infection is more effective,and can reduce the death caused by bloodstream infection.