• 1 蘇州大學附屬第一醫(yī)院呼吸科(江蘇蘇州 215006);;
  • 2 蘇州大學附屬第一醫(yī)院血液科;

目的  探討免疫低下宿主敗血癥的病原譜和臨床特征。方法  回顧性分析160例免疫低下宿主敗血癥患者的基礎疾病、外周血粒細胞計數(shù)、血培養(yǎng)時的體溫、治療及轉歸。結果  160例患者中,8例發(fā)生2次敗血癥,3例為復數(shù)菌敗血癥,共檢出病原體171株;其中革蘭陽性球菌37株(21.6%)、革蘭陽性桿菌6株(3.5%)、革蘭陰性桿菌113株(66.1%)、真菌l5株(8.8%)。革蘭陽性球菌以葡萄球菌屬和鏈球菌屬為主,分別為17株和14株;革蘭陽性桿菌以棒狀桿菌屬為主,有5株;革蘭陰性桿菌中以大腸埃希氏菌、肺炎克雷白桿菌和銅綠假單胞菌多見,分別為60株、20株和15株。17株葡萄球菌中,金黃色葡萄球菌有12株,均對甲氧西林敏感(MSSA);113株革蘭陰性桿菌中有20株產(chǎn)超廣譜β內酰胺酶(ESBLs),分別為大腸埃希氏菌17株、肺炎克雷白桿菌2株和產(chǎn)酸克雷白桿菌1株。真菌敗血癥均由念珠菌屬感染所致,白色念珠菌4株、非白色念珠菌11株。中性粒細胞減少者120例(75%),其中103例為粒細胞缺乏癥(粒缺)患者。70%的敗血癥患者出現(xiàn)高熱。所有患者均接受了廣譜抗生素治療,58.8%的患者同時采取了抗真菌治療。死亡20例,19例因病情惡化而放棄治療,治愈好轉率為75.6%。結論  免疫低下宿主敗血癥中,細菌感染是首要病因,真菌的檢出率呈上升趨勢,粒缺是敗血癥發(fā)生的危險因素之一,高熱是其重要體征。

引用本文: 陳延斌 ,黃建安,凌春華,雷偉,陶岳多,何廣勝. 免疫低下宿主敗血癥160例臨床分析. 中國呼吸與危重監(jiān)護雜志, 2008, 08(1): 30-34. doi: 復制

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8. 周鐵麗,王賽芳,李超,等.醫(yī)院感染敗血癥病原菌8年變遷及耐藥性分析.中華醫(yī)院感染學雜志,2006,16:825-827.
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10. 羅雅玲,彭道波,朱建軍,等.90年代金黃色葡萄球菌敗血癥臨床分析.中國綜合臨床,2001,17:595.
11. 王輝,吳偉元,陳民鈞.腸桿菌科細菌中超廣譜β-內酰胺酶(ESBL)的研究.中華微生物學和免疫學雜志,2001,21:676-679.
12. 中華內科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(草案).中華內科雜志,2005,44:554-556.
13. 中華內科雜志編輯委員會.侵襲性肺部真菌感染的診斷標準與治療原則(草案).中華內科雜志,2006,45:697-700.
14. Shorr AF,Tabak YP,Killian AD,et al.Healthcare-associated bloodstream infection:A distinct entity? Insights from a large U.S.database.Crit Care Med,2006,34:2588-2595.
15. Falagas ME,Apostolou KE,Pappas VD.Attributable mortality of candidemia:a systematic review of matched cohort and case-control studies.Eur J Clin Microbiol Infect Dis,2006,25:419-425.
16. 王愛霞,鄧國華.從敗血癥觀察院內真菌感染的動向.中華內科雜志,2002,41:489-490.
17. Zaoutis TE,Greves HM,Lautenbach E,et al.Risk factors for disseminated candidiasis in children with candidemia.Pediatr Infect Dis J,2004,23:635-641.
18. Richardson MD.Changing patterns and trends in systemic fungal infections.J Antimicrob Chemother,2005,56(Suppl 1):i5-i11.
19. 丁士芳,周煒,孫恩華,等.念珠菌敗血癥23例臨床分析.中國抗感染化療雜志,2004,4:268-270.
20. Nakamura T,Takahashi H.Epidemiological study of Candida infections in blood:susceptibilities of Candida spp.to antifungal agents,and clinical features associated with the candidemia.J Infect Chemother,2006,12:132-138.
21. Bakir M,Cerikcioglu N,Barton R,et al.Epidemiology of candidemia in a Turkish tertiary care hospital.APMIS,2006,114:601-610.
22. 黃志剛,陸文熊,李明發(fā).真菌性敗血癥的病因及耐藥分析.中華檢驗醫(yī)學雜志,2003,26:565.
23. 吳安華,文細毛,任南,等.醫(yī)院內菌血癥發(fā)病率與病原體分析.中華醫(yī)學雜志,2003,83:395-398.
  1. 1. Gea-Banacloche JC,Opal SM,Jorgensen J,et al.Sepsis associated with immunosuppressive medications:an evidence-based review.Crit Care Med,2004,32(Suppl 11):S578-S590.
  2. 2. Riedemann NC,Guo RF,Ward PA.The enigma of sepsis.J Clin Invest,2003,112:460-467.
  3. 3. Urabe A.Clinical features of the neutropenic host:definitions and initial evaluation.Clin Infect Dis,2004,39(Suppl 1):S53-S55.
  4. 4. Mendes AV,Sapolnik R,Mendonça N,et al.New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients.J Pediatr (Rio J),2007,83(Suppl 2):S54-S63.
  5. 5. Sobel JD.Design of clinical trials of empiric antifungal therapy in patients with persistent febrile neutropenia:considerations and critiques.Pharmacotherapy,2006,26(6 Pt 2):47S-54S.
  6. 6. Klastersky J.Management of fever in neutropenic patients with different risks of complications.Clin Infect Dis,2004,39(Suppl 1):S32-S37.
  7. 7. Kanamaru A,Tatsumi Y.Microbiological data for patients with febrile neutropenia.Clin Infect Dis,2004,39(Suppl 1):S7-S10.
  8. 8. 周鐵麗,王賽芳,李超,等.醫(yī)院感染敗血癥病原菌8年變遷及耐藥性分析.中華醫(yī)院感染學雜志,2006,16:825-827.
  9. 9. 王麗珍,張?zhí)焱?耐甲氧西林金黃色葡萄球菌感染的現(xiàn)狀和研究進展.國際呼吸雜志,2006,26:917-919.
  10. 10. 羅雅玲,彭道波,朱建軍,等.90年代金黃色葡萄球菌敗血癥臨床分析.中國綜合臨床,2001,17:595.
  11. 11. 王輝,吳偉元,陳民鈞.腸桿菌科細菌中超廣譜β-內酰胺酶(ESBL)的研究.中華微生物學和免疫學雜志,2001,21:676-679.
  12. 12. 中華內科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(草案).中華內科雜志,2005,44:554-556.
  13. 13. 中華內科雜志編輯委員會.侵襲性肺部真菌感染的診斷標準與治療原則(草案).中華內科雜志,2006,45:697-700.
  14. 14. Shorr AF,Tabak YP,Killian AD,et al.Healthcare-associated bloodstream infection:A distinct entity? Insights from a large U.S.database.Crit Care Med,2006,34:2588-2595.
  15. 15. Falagas ME,Apostolou KE,Pappas VD.Attributable mortality of candidemia:a systematic review of matched cohort and case-control studies.Eur J Clin Microbiol Infect Dis,2006,25:419-425.
  16. 16. 王愛霞,鄧國華.從敗血癥觀察院內真菌感染的動向.中華內科雜志,2002,41:489-490.
  17. 17. Zaoutis TE,Greves HM,Lautenbach E,et al.Risk factors for disseminated candidiasis in children with candidemia.Pediatr Infect Dis J,2004,23:635-641.
  18. 18. Richardson MD.Changing patterns and trends in systemic fungal infections.J Antimicrob Chemother,2005,56(Suppl 1):i5-i11.
  19. 19. 丁士芳,周煒,孫恩華,等.念珠菌敗血癥23例臨床分析.中國抗感染化療雜志,2004,4:268-270.
  20. 20. Nakamura T,Takahashi H.Epidemiological study of Candida infections in blood:susceptibilities of Candida spp.to antifungal agents,and clinical features associated with the candidemia.J Infect Chemother,2006,12:132-138.
  21. 21. Bakir M,Cerikcioglu N,Barton R,et al.Epidemiology of candidemia in a Turkish tertiary care hospital.APMIS,2006,114:601-610.
  22. 22. 黃志剛,陸文熊,李明發(fā).真菌性敗血癥的病因及耐藥分析.中華檢驗醫(yī)學雜志,2003,26:565.
  23. 23. 吳安華,文細毛,任南,等.醫(yī)院內菌血癥發(fā)病率與病原體分析.中華醫(yī)學雜志,2003,83:395-398.
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