异基因造血干细胞移植后患者血流感染的病原学特征及临床结果

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【中图分类号】R446.5 【文献标志码】A

【AbstractObectiveTinvesgatethogicalcharacteristicsofbloodstrainfecs（BSIs）inpatintsafteralgenict poieticstemcelltransplantation（all-HSCT）andtheirimpactonteclinicaloutcomeofpatients.Methods：Aretrospectivecohort study was conducted among the patients，aged > 14 years，who underwent allo-HSCT in The First Affiliated Hospital of Soochow Universityn202-Ondtheatientsereaaledinsfpopulatiohracteristis，rutiofpathgeiccteriafors sistance to commonly used antibiotics，and 30-dayoverallsurvival.Results：Among the1682 patients，129（ 7.67% ）experienced BSIs fterall-HSCT，with39episodesintotal.ThepathogenicbacteriacausingBSIswereGram-negativebacteriain98patients （ 76.0% ），Gram-positive bacteria in 14 patients （ 10.9% ），fungi in7patients（ 5.4% ），and multiple microorganisms in 1O patients （ 7.8% ）.AmongtheGram-negativebacteria，theisolatesresistanttoceftriaxone，cefepime，andpiperacilin-tazobactamaccountedfor 86.2 % ，68.1%，and77.9%，respectively.Theoverall drugresistancerates tociprofloxacinand imipenem were57.9%and 39.4 % ， respectively. Enterococcus isolates showed a penicillin resistance rate of 93.8% .Eight isolates of Candida tropicalis were resistant to fluconazoleandweresensitivetobothamphotericinBandflucytosine.Thereasasignificantdiferencein3O-dayoveralsurvival between the patients with BSIs caused by different types of pathogenic bacteria（ P<0.001 ），and the patients with fungal BSIs had a significantly lower 3O-day overall survival rate than those with Gram-negative bacteria（ P<0.001 ），Gram-positive bacteria（ P =0.004）， and polymicrobial BSIs（ P=0.013 ）.Fungal BSIsand non-Hodgkin's lymphoma were associated with the relativelylow 3O-day overall survivalateinpatints.Conclusionhissudyvealsteetiologialharacteristicsnd3Odaoverallsurvialofpatintswihsafterallo-HSCT，which provides strong support for empirical antimicrobial therapyand infection prevention strategies forpatientswith BSIs after allo-HSCT.

【Key words】bloodstream infections; hematopoietic stem cel transplantation;antibiotic resistance

异基因造血干细胞移植（allogeneichematopoi-eticstemcelltransplantation，allo-HSCT）被认为是治疗恶性血液病以及部分非恶性血液疾病最有效的治疗手段。（剩余10461字）