| Objective: To analyze the etiology and clinical characteristics of 72 patients who received Hematopoietic stem cell transplantation(HSCT)combined with bacterial infection in the first affiliated hospital of guangxi medical university from 2013 to 2017,and to explore the severity of bacterial infection and its relationship with gender,age,nationality,disease type,blood type and human leukocyte antigen.The relationship between HLA,graft-versus-host disease(GVHD),veno-oeclusive disease of the liver(VOD),the state of recurrence after transplantation,and the state of disease at the time of transplantation provides scientific basis for clinical prevention and treatment.At the same time,analysis and comparison the first affiliated hospital of guangxi medical university from 2013 to 2017 heavy beta thalassaemia(beta thalassemia,beta TM)patients with Acute Leukemia(Acute Leukemia,AL)in patients with hematopoietic stem cell transplantation(HSCT)specimens of amalgamative bacterium infection of pathogenic bacteria,pathogenic bacteria species,sensitive and resistant rate of pathogenic bacteria to the appropriate antibiotics,for reasonable choice of antibiotics,improve the effect of clinical treatment and reduce mortality.Methods: Were retrospectively analyzed between January 2013 and December 2017,the first affiliated hospital of guangxi medical university 72 routine hematopoietic stem cell transplantation with bacteria infection in the etiology and clinical characteristics of patients,the Kirby-Bauer(K-B)disc diffusion method and VITEK-2 Compact60 microbial analysis system and related consumable reagents in drug sensitive test,combined with gender,age,nationality,type of disease,graft versus host disease,state of recurrence after transplantation,transplantation in disease states such as analysis of influence factors associated with the severity of infection after transplantation,WHONET5.6 software was used to analyze bacterial strains and drug resistance,and IBM SPSS17.0 software was used for statistical analysis of clinical data.Collected at the same time between January 2013 and December 2017,the first affiliated hospital of guangxi medical university heavy beta thalassaemia patients with acute leukemia patients with hematopoietic stem cell transplantation(HSCT)consolidated the bacterial infection,clinical specimens isolates the K-B paper diffusion method and VITEK-2 Compact60 microbial analysis system and related consumable reagents in drug sensitive test,WHONET5.6 was used to analyze the bacterial strain's Sensitive rates(S)and Resistance rates(R),and IBM SPSS17.0 software was used to analyze the clinical data.Results: among the 72 cases of hematopoietic stem cell transplantation combined with bacterial infection,22 cases were non-severe infection(30.56%)and 50 cases were severe infection(69.44%).Ten cases(13.89%)were fatal.Recurrence status after transplantation was related to the severity of infection(P < 0.05),and was not related to other factors.A total of 142 strains of pathogenic bacteria were isolated and cultured from 72 patients with hematopoietic stem cell transplantation combined with bacterial infection.Blood was the most important source of pathogenic bacteria,followed by sputum,which was 58.45% and 14.08%,respectively.Among the pathogenic bacteria,29 strains(20.42%)were gram-positive bacteria,in which enterococcus sphaerobacteriae took the first place,followed by staphylococcus epidermidis and staphylococcus aureus.Two strains of vancomycin-resistant enterococcus faecalis were detected.Staphylococcus epidermidis and staphylococcus aureus were highly sensitive to linezolid,vancomycin and tegacycline,with the sensitivity rate of 100%.Gramnegative bacteria(g-bacteria)113 strains(79.58%),mainly pseudomonas aeruginosa,escherichia coli,klebsiella pneumoniae and enterobacter cloacae;Gram-negative bacteria were the main pathogens detected in each year.Antimicrobial susceptibility test results: the sensitivity rate of gram-positive bacteria to linezolid and tegacycline was 100%,the drug resistance rate of penicillin G was 100%,and the detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 100%.The drug resistance rate of enterococcus faecalis to penicillin,quinolones and macrolides was 100%.The drug resistance rate of nitrofurantoin was 50% and that of tetracycline was between 50-75%.The drug resistance rate of high concentration gentamicin and streptomycin was 80%.Two strains of enterococcus faecalis resistant to vancomyces were detected.The drug resistance rate of staphylococcus epidermidis,esfanilamide and erythromycin was 100%.The drug resistance rate of rifamycin was 50%.The drug resistance rate to quinolones was 16.7%.The drug resistance rate to tetracycline was 33.33%.Staphylococcus aureus is resistant to all antibiotics except penicillin G and benzocillin.No vancomycin-resistant staphylococcus was detected,and the sensitivity rate was 100%.The drug resistance rates of pseudomonas aeruginosa to ampicillin,amoxicillin/clavuric acid,cefazolin,ceftriaxone and compound xinnomin were extremely high,all of which were 100%.It was 100% sensitive to polymyxin B.The drug resistance rate of amitractam was 20%.The drug resistance rates of imipenem and meropenem were 56% and 26.3% respectively.Drug resistance to aminoglycosides was 52%.The detection rate of Extended-spectrum lactamases(ESBLs)in escherichia coli was 60.9%,that in esbl-producing klebsiella pneumoniae was 81.8%,both of which were 100% resistant to ampicillin and piperacillin and 100% sensitive to ertapenem.The e drug resistance rates of escherichia coli to amoxicillin/clavuric acid,piperacillin/tazobactam,cefoxitin,amitracillin,imipenem,meropenem,amikacin and compound xinnomin were 38.9%,26.1%,21.7%,56.5%,21.7%,31.6%,13%,73.9%,respectively.The drug resistance rates of gentamicin and tobramycin were 82.6% and 73.9%,respectively.The drug resistance rate of cephalosporins was 43.5-91.3%.The drug resistance rate of quinolone antibiotics was 69.6%.The drug resistance rates of klebsiella pneumoniae to amoxicillin/clavuric acid,piperacillin/tazobactam,cefoxitin,amitracillin and compound xinnomin were 33.3%,27.3%,27.2%,59.1% and 68.2%,respectively.The drug resistance rate of cephalosporins was 31.8-81.8%.The sensitivity rates to imipenem and meropenem were 100% and 83.3%,respectively.The drug resistance rate of aminoglycoside antibiotics was 18.2-63.6%.The drug resistance rates to ciprofloxacin and levofloxacin were 50% and 40.9%,respectively.The drug resistance rates of enterobacter cloacae against piperacilin,amoxicillin/clavulac,piperacilin/tazobactam,cefepime,amitracillin and compound xinnomin were 94.4%,100%,11.1%,16.7%,55.6% and 77.8%,respectively.The drug resistance rates of ceftriaxone and ceftazidime were 94.4% and 33.3%,respectively.The sensitivity rate to carbapenems antibiotics was 100%.The drug resistance rates of amikacin,gentamicin and tobramycin were 44.4%,94.4% and 94.4%,respectively.The drug resistance rate of quinolone antibiotics was 5.6%.The above four bacteria were all 100% sensitive to cefoperazone/sulbactam and tegacycline.The drug resistance rate of esbl-producing strains represented by klebsiella pneumoniae was high: except for ampicillin,piperacillin,cefoperazone/sulbactam,ertapenem,imipenem and tegacycline,the drug resistance rate of esbl-producing klebsiella pneumoniae was higher than that of non-esbl-producing klebsiella pneumoniae.Detection of multidrug-resistant bacteria: the detection rate of vancomycinresistant enterococci(VRE)is 18.2%;The detection rate of e.coli resistant to carbapenems was 21.74%,that of e.coli producing lactamase was 60.9%,and that of klebsiella pneumoniae producing lactamase was 81.8%.The detection rates of Carbapenems resistant acinetobacter baumannii(cr-ab)and Carbapenems resistant pseudomonas aeruginosa(cr-pa)were 33.3% and 56%,respectively.The detection rate of methicillin-resistant staphylococcus aureus(MRSA)was 100%.Blood and central catheter were the main pathogens of hematopoietic stem cell transplantation combined with bacterial infection in patients with severe thalassemia.Blood and sputum were the main pathogens of hematopoietic stem cell transplantation combined with bacterial infection in patients with acute leukemia.Severe beta thalassaemia patients hematopoietic stem cell transplantation with bacteria infection of pathogenic bacteria species with epidermis staphylococcus aureus,e.coli,pseudomonas aeruginosa,hematopoietic stem cell transplantation in patients with acute leukemia with bacteria infection of pathogenic bacteria species with klebsiella pneumoniae,pseudomonas aeruginosa,e.coli is given priority to;Gram-negative bacteria were more than gram-positive bacteria in both samples.The drug resistance rate of gram-positive bacteria(G+ bacteria)in acute leukemia group was significantly higher than that in gentamicin,ciprofloxacin,levofloxacin and furantoin group(P < 0.05),and there was no significant difference in the drug resistance rate of other antibiotics(P > 0.05).The drug resistance rate of gram negative bacteria(G-bacteria)in acute leukemia group was significantly higher than that of gram negative bacteria in ampicillin,piperacillin and ciprofloxacin group(P < 0.05),and there was no significant difference in drug resistance rate of other antibiotics(P > 0.05).Conclusion: the incidence of severe infection in patients with hematopoietic stem cell transplantation combined with bacterial infection is higher than that of nonsevere infection.Recurrence status after transplantation was related to the severity of infection(P < 0.05),but not related to other factors(P > 0.05).The main site of infection is blood;The pathogens of infection were mainly gram-negative bacteria.Pseudomonas aeruginosa ranked the first,eco ranked the second,klebsiella pneumoniae ranked the third,and enterobacter cloacae ranked the fourth.Gram-negative bacteria were the main pathogens detected in each year.Enterococcus faecalis,staphylococcus epidermidis and staphylococcus aureus were the most common gram-positive bacteria.The drug resistance rate of ESBLs producing strain was high.The detection rate of multidrug-resistant bacteria is high.The distribution and species of pathogenic bacteria samples were different in severe thalassemia patients and acute leukemia patients after hematopoietic stem cell transplantation combined with bacterial infection.Gram-negative bacteria were more than gram-positive bacteria in both samples.The detection of the pathogen resistance is different also,acute leukemia group of gram-positive bacteria to gentamicin,ciprofloxacin,levofloxacin,with nitrofurantoin due to significantly higher percentages of heavy beta thalassaemia group of grampositive bacteria(P < 0.05),the acute leukemia group of gram-negative bacteria to ampicillin,piperacillin,ciprofloxacin,significantly higher percentages of heavy beta of Mediterranean anemia group of gram-negative bacteria(P < 0.05). |
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