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目的分析慢性淋巴细胞白血病(CLL)患者医院感染的病原菌分布及危险因素。方法回顾性分析2010年1月至2015年12月CLL患者64例的临床资料,观察CLL患者医院感染发生率、感染部位、病原菌的构成及病原菌耐药情况。对发生医院感染的相关因素行单因素检验和多因素的非条件logistic回归分析。结果 64例CLL患者中发生院内感染26例,感染发生率为40.6%。26例院内感染患者中,呼吸道感染发生率最高为14例(21.8%),共检测出病原菌株7株,革兰阴性杆菌株4株,分别为肺炎克雷伯菌2株,大肠埃希菌2株;革兰阳性球菌株2株,为金黄色、表皮葡萄球菌各1株;真菌菌株为1株,为光滑假丝酵母菌。单因素分析显示,CLL患者院内感染与患者化疗方案、疾病分期、粒细胞缺乏持续时间(粒缺时间)、血红蛋白水平、白蛋白水平、CD4~+T淋巴细胞有关(P<0.05,P<0.01)。多因素logistic回归分析显示,CD4~+T淋巴细胞≤0.5×109/L、血红蛋白≤100 g/L、含氟达拉滨的化疗方案为CLL患者院内感染的危险因素(P<0.05,P<0.01)。结论根据CLL患者医院感染的特点,CLL发生院内感染时,可对其危险因素进行干预,感染发生后,应选用敏感抗菌药物进行治疗。
Objective To analyze the distribution and risk factors of nosocomial infections in patients with chronic lymphocytic leukemia (CLL). Methods The clinical data of 64 patients with CLL from January 2010 to December 2015 were retrospectively analyzed. The incidence of nosocomial infection, the site of infection, the composition of pathogens and the drug resistance of pathogens in CLL patients were observed. Univariate test and multivariate non-conditional logistic regression analysis were performed on the related factors of nosocomial infection. Results Sixty-six cases of nosocomial infection occurred in 64 CLL patients, the incidence of infection was 40.6%. Among the 26 nosocomial infections, the highest incidence of respiratory infections was 14 (21.8%). Seven pathogens and 4 Gram-negative bacilli were detected, which were 2 strains of Klebsiella pneumoniae and 5 strains of Escherichia coli 2; Gram-positive cocci strains 2 strains, golden yellow, Staphylococcus epidermidis a strain; fungi strain was 1, for the smooth Candida. Univariate analysis showed that nosocomial infections in patients with CLL were associated with chemotherapy regimen, disease stage, duration of agranulocytosis, hemoglobin level, albumin level and CD4 ~ + T lymphocytes (P <0.05, P <0.01) ). Multivariate logistic regression analysis showed that CD4 ~ + T lymphocytes ≤0.5 × 109 / L and hemoglobin ≤100 g / L, and the chemotherapy regimen with fludarabine was the risk factor for nosocomial infection in CLL patients (P <0.05, P < 0.01). Conclusion According to the characteristics of nosocomial infection in CLL patients, when CLL occurs nosocomial infection, its risk factors may be intervened. After the infection occurs, sensitive antibacterials should be used for treatment.