Predisposing Factor And Clinical Feature Of Pulmonary Infection In Patients With Newly Diagnosed Multiple Myeloma

Objective: Retrospective analysis of the clinical datas of patients with multiple myeloma(MM),summarized the clinical characteristics and related susceptibility factors of pulmonary infection in newly diagnose MM patients.In addition,the pathogenic analysis of the MM patients with pulmonary infection,and the drug selection and efficacy of anti infection treatment were summarized.It provides a clinical basis for early detection and effective treatment of pulmonary infection in MM patients.Method: 176 patients with newly diagnosed MM clinical datas come from the data system in Guangxi Medical University Affiliated Tumor Hospital from January 2011 to December 2017.Without pulmonary infection before chemotherapy was 88 cases,pulmonary infections were 88 cases.The case data of the patients were collected and the incidence of MM combined with pulmonary infection was analyzed by comparing the incidence of infection in each group.The etiology,clinical characteristics and treatment of pulmonary infection were analyzed and summarized.Result:1.Infection related susceptibility factors: compare with the incidence of infection of each observation index,through single factor analysis by chi square test,the difference has statistically significant index of smoking history,ECOG score,DS staging,anemia,albumin,CRP.Having a history of smoking,poor physical status,late DS stages,anemia,and hypoproteinemia in patients with high infection rates.The results showed that ECOG score,DS stage and CRP were independent risk factors for multiple myeloma with pulmonary infection.2.MM combined with pulmonary infection clinical manifestations: clinical cough,sputum 48.86%,fever 25%,chest tightness 17.05%,no symptoms(32.95%),It shows that many patients with pulmonary infection have no obvious clinical symptoms and need to be diagnosed by imaging examination.3.The etiology: 35 patients with etiological examination,positive rate of42.86%(15/35).Fungal infection was the main cause,including 8 cases with simple fungal infection,4 cases with mixed fungal and gram negative bacteria,2cases with gram negative bacteria infection,1 cases with Gram-positive bacteria infection.4.Imaging findings are characterized by two pulmonary lesions,mostly patchy shadows,and often accompanied by pleural effusion.Routine imaging examinations are helpful to find the early detection of asymptomatic pulmonary infection.5.The antibiotics of pulmonary infection in our hospital are mostly empiric drugs,the commonly used antibiotics are compound beta lactam antibiotics,followed by quinolones and antifungal drugs.The main combination is twocombination.The most commonly used scheme is piperacillin / sulbactam combined with levofloxacin.The total effective rate of anti infection is 61.11%.The effective rate of 2-linked anti-bacterial treatment was 70.45 %.88 MM combined.7 patients with pulmonary infection died of lung infection.Conclusion:1.The infection rate of lung infection in newly diagnosed MM patients is high and many patients lack obvious clinical symptoms.2.Smoking history,ECOG score,DS stage,anemia,albumin and CRP were predisposing factors for MM complicated with pulmonary infection.ECOG score,DS stage and CRP were independent risk factors.3.Imaging examination showed that two pulmonary lesions were common,most of which were patchy shadows,often accompanied by pleural effusion,and early detection of lung lesions could be found by early imaging examination.4.The use of bortezomib based chemotherapy regimens can improve the efficiency of anti infection treatment,because lung infection is easy to relapse during chemotherapy and should be treated empirically.5.The effective rate of empirical combined antibacteriological treatment is70.45%,and simple and mixed fungal infection in phlegm culture is common,suggesting that combined antifungal therapy may further improve the efficacy of anti infection.