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目的:探讨血液科住院患者发生血流感染的病原菌分布特点及可能引起血流感染的内外源性高危因素。方法:采用前瞻性队列研究方法,将血液科2014年01至12月92例血培养阳性患者作为研究对象,将同时期抽取血培养的92例血培养阴性患者作为对照组,将其血流感染前可能存在的内外源性高危因素进行分层研究,并随访患者血流感染后的住院时间及生存情况,相关数据采用SPSS软件进行统计学分析。结果:血液科2014年血流感染主要为革兰阴性杆菌(73.91%),前5位依次为大肠埃希菌(30.43%)、肺炎克雷伯杆菌(15.22%)、鲍曼不动杆菌(6.52%)、嗜水气单胞菌(5.43%)、铜绿假单胞菌(4.35%);其次为革兰阳性球菌(19.57%),前3位依次为肺炎链球菌(5.43%)、施氏葡萄球菌(3.26%)、草绿色链球菌(3.26%);真菌(6.52%)皆为念珠菌属。粒细胞缺乏及合并弥散性血管内凝血(DIC)在2组之间差异有统计学意义(P<0.01)。在30d随访期内,血流感染组的死亡率(38.04%)明显高于对照组(21.74%)。结论:血流感染是影响血液病住院患者疗效的一个重要不利因素。而中性粒细胞缺乏或合并DIC状态是引起血液病患者血流感染发生的高危因素。
Objective: To investigate the distribution of pathogenic bacteria in bloodstream inpatients with hematology and the exogenous and exogenous risk factors that may lead to bloodstream infection. Methods: A prospective cohort study was conducted in 92 hematologic positive patients from January to December 2014 in Hematology Department. 92 blood culture-negative patients who underwent blood culture during the same period were selected as control group. Bloodstream infection Stratified study of exogenous and exogenous risk factors that may exist before, followed-up hospitalization time and survival after bloodstream infection, and the related data were analyzed by SPSS software. Results: The majority of bloodstream infections in Hematology were Gram-negative bacilli (73.91%) in 2014, followed by Escherichia coli (30.43%), Klebsiella pneumoniae (15.22%), Acinetobacter baumannii 6.52%), Aeromonas hydrophila (5.43%) and Pseudomonas aeruginosa (4.35%), followed by Gram-positive cocci (19.57%), followed by Streptococcus pneumoniae (5.43%) Staphylococcus aureus (3.26%), Streptococcus viridans (3.26%); fungi (6.52%) are Candida. There was a significant difference between the two groups in the number of agranulocytosis and diffuse intravascular coagulation (DIC) (P <0.01). During the follow-up period of 30 days, the mortality rate of bloodstream infection group (38.04%) was significantly higher than that of the control group (21.74%). Conclusion: Bloodstream infection is an important adverse factor affecting the efficacy of inpatients with hematological diseases. Neutropenia or combined with DIC status is a risk factor for bloodstream infections in patients with blood diseases.