白血病并发感染的危险因素、病原菌种类特点及预防措施
Risk Factors, Pathogenic Bacteria Species Characteristics and Control Status of Leukemia Concurrent Infection
DOI: 10.12677/ACM.2023.1351218, PDF,   
作者: 徐 丽*:大理大学临床医学院,云南 大理;李永萍*:大理大学第一附属医院血液内科,云南 大理
关键词: 白血病感染危险因素预防措施Leukemia Infection Risk Factors Preventive Measures
摘要: 白血病患者由于疾病本身的异质性及治疗的特殊性,免疫功能受损,在整个治疗过程中的感染率相对较高。在临床上,感染是导致恶性血液病患者死亡的重要原因。但是由于病原菌培养耗时长且阳性率低,有时缺乏典型感染的症状以及影像学特征等,导致早期难以确诊,从而延误诊治,影响化疗的疗效及患者预后。本文就白血病患者感染的危险因素、病原菌特点及当前预防措施现状进行综述。
Abstract: Due to the heterogeneity of the disease itself and the particularity of treatment, the immune func-tion of leukemia patients is impaired, and the infection rate is relatively high in the whole course of treatment. Infection is one of the most important causes of death in patients with hematologic ma-lignancies. However, due to the long time of pathogen culture and low positive rate, sometimes there is a lack of typical symptoms and signs of infection as well as clear pathogens and infection focus. Some patients may not be clinically feverish and have no specific early imaging signs even if infection occurs, which leads to difficult early diagnosis and treatment, and thus affects the efficacy of chemotherapy and the prognosis of patients. This paper reviews the characteristics of pathogenic bacteria in leukemia patients and the current status of prevention measures.
文章引用:徐丽, 李永萍. 白血病并发感染的危险因素、病原菌种类特点及预防措施[J]. 临床医学进展, 2023, 13(5): 8715-8721. https://doi.org/10.12677/ACM.2023.1351218

参考文献

[1] 何小群, 陈松, 刘春荣, 等. 抗菌药物使用频率与细菌耐药性的相关性研究[J]. 右江医学, 2015, 43(6): 653-657.
[2] 凌纯, 陆美荣, 焦蓓蕾, 等. 儿童急性淋巴细胞白血病诱导化疗期合并脓毒症31例回顾分析[J]. 广西医科大学学报, 2017, 34(5): 762-764.
[3] Pappas, P.G., Kauffman, C.A., Andes, D.R., et al. (2016) Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 62, e1-e50. [Google Scholar] [CrossRef] [PubMed]
[4] Sun, Y.Q., Meng, F.Y., Han, M.Z., et al. (2015) Epidemiology, Manage-ment, and Outcome of Invasive Fungal Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation in China: A Multicenter Prospective Observational Study. Biology of Blood and Marrow Transplantation, 21, 1117-1126. [Google Scholar] [CrossRef] [PubMed]
[5] 刘群慧, 张甜, 胡月, 等. 血液恶性肿瘤患者特异性支持照护需求量表的编制及信效度检验[J]. 现代预防医学, 2019, 46(4): 669-673.
[6] 何小珍, 周雁, 张元亮, 等. 非平面多环芳烃[4]helicenium通过促进凋亡选择性杀伤血液恶性肿瘤细胞[J]. 肿瘤, 2020, 40(9): 589-601.
[7] 张启科, 李青芬, 张浩军, 等. 急性白血病并发感染的研究进展[J]. 中华医院感染学杂志, 2019, 29(11): 1756-1760.
[8] Lucas, N., Humble, M., Sim, D., et al. (2017) Temporal Changes in Neutropenic Blood Culture Iso-lates and Disease Associations: A Single Centre Series of 1139 Episodes. Internal Medicine Journal, 47, 962-965. [Google Scholar] [CrossRef] [PubMed]
[9] Ali, A.M., Mirrakhimov, A.E., Abboud, C.N. and Cashen, A.F. (2016) Leukostasis in Adult Acute Hyperleukocytic Leukemia: A Clinician’s Digest. Hematological Oncology, 34, 69-78. [Google Scholar] [CrossRef] [PubMed]
[10] Flowers, C.R., Seidenfeld, J., Bow, E.J., et al. (2013) Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 31, 794-810. [Google Scholar] [CrossRef
[11] Cherif, H., Björkholm, M., Engervall, P., et al. (2004) Prospective, Randomized Study Comparing Cefepime and Imipenem-Cilastatin in the Empirical Treatment of Febrile Neutropenia in Patients Treated for Haematological Malignancies. Scandinavian Journal of Infectious Diseases, 36, 593-600. [Google Scholar] [CrossRef] [PubMed]
[12] Rossini, F., Terruzzi, E., Verga, L., et al. (2005) A Randomized Clinical Trial of Ceftriaxone and Amikacin versus Piperacillin Tazobactam and Amikacin in Febrile Patients with Hema-tological Neoplasia and Severe Neutropenia. Support Care Cancer, 13, 387-392. [Google Scholar] [CrossRef] [PubMed]
[13] Viscoli, C., Cometta, A., Kern, W.V., et al. (2006) Piperacil-lin-Tazobactam Monotherapy in High-Risk Febrile and Neutropenic Cancer Patients. Clinical Microbiology and Infection, 12, 212-216. [Google Scholar] [CrossRef] [PubMed]
[14] Keng, M.K. and Sekeres, M.A. (2013) Febrile Neutropenia in Hematologic Malignacies. Current Hematologic Malignancy Reports, 8, 370-378. [Google Scholar] [CrossRef] [PubMed]
[15] Demirel, A., Tabak, F., Ar, M.C., et al. (2015) Secondary Infec-tions in Febrile Neutropenia in Hematological Malignancies: More than Another Febrile Neutropenic Episode. Turkish Journal of Haematology, 32, 243-250. [Google Scholar] [CrossRef] [PubMed]
[16] 贾晓艳, 陈琳, 魏旭东. 年龄对初治急性髓系白血病患者初次诱导治疗后中性粒细胞缺乏时间的影响[J]. 中国实验血液学杂志, 2022, 30(1): 43-48.
[17] Park, J.H. and Park, H.W. (2012) Hong Seok-Hoo’s Translation of “New Edition of Physiology Textbook” (1906) and Its Meanings. Korean Journal of Medical History, 21, 477-512.
[18] Stefanski, M., Jamis-Dow, C., Bayerl, M., et al. (2016) Chest Radio-graphic and CT Findings in Hyperleukocytic Acute Myeloid Leukemia: A Retrospective Cohort Study of 73 Patients. Medicine (Baltimore), 95, e5285. [Google Scholar] [CrossRef
[19] 刘盼, 刘明辉, 周芙玲. 急性高白细胞白血病临床特点回顾性分析[J]. 医学新知, 2020, 30(3): 233-238.
[20] 陆亚岚, 张欣, 陈世明, 等. 急性白血病患者化疗后感染的影响因素研究[J]. 实用临床医药杂志, 2017, 21(3): 185-187.
[21] 梁利杰, 梁华杰, 孙慧. 急性白血病患者化疗后感染的临床分析[J]. 中华医院感染学杂志, 2014(15): 5471-5473.
[22] Edwards, B.K., Noone, A.M., Mariotto, A.B., et al. (2014) Annual Report to the Nation on the Status of Cancer, 1975-2010, Featuring Prevalence of Comorbidity and Impact on Survival among Persons with Lung, Colorectal, Breast, or Prostate Cancer. Cancer, 120, 1290-1314. [Google Scholar] [CrossRef] [PubMed]
[23] Chen, Y.G., Pan, H.H., Dai, M.S., et al. (2015) Impact of Comorbidity and Age on Determinants Therapeutic Strategies in Advanced Pancreatic Head Cancer Patients with Obstructive Jaundices. Medicine (Baltimore), 94, e1298. [Google Scholar] [CrossRef
[24] Haller, D.G., O’Connell, M.J., Cartwright, T.H., et al. (2015) Impact of Age and Medical Comorbidity on Adjuvant Treatment Outcomes for Stage III Colon Cancer: A Pooled Analy-sis of Individual Patient Data from Four Randomized, Controlled Trials. Annals of Oncology, 26, 715-724. [Google Scholar] [CrossRef] [PubMed]
[25] 赵燕, 饶爱华, 孙密芬, 等. 伏立康唑和伊曲康唑治疗血液恶性肿瘤继发真菌感染的临床疗效及对血清炎症因子的作用[J]. 中华医院感染学杂志, 2018, 28(5): 703-706, 714.
[26] 邓黎黎, 曾鹏云, 马丽辉, 等. 急性髓系白血病诱导缓解期患者下呼吸道感染病原菌分布与相关因素分析[J]. 中华医院感染学杂志, 2017, 27(16): 3647-3650.
[27] 郭文坚, 黄河, 何牧卿, 姚荣欣, 等. 共患病评分在急性髓系白血病患者化疗并发症中的判断研究[J]. 中华全科医学, 2017, 14(9): 1501-1503.
[28] 刘联斌, 黄刚, 郭守俊, 等. 晚期肺癌患者化疗后肺部感染的病原菌分布和对免疫功能的影响研究[J]. 中华医院感染学杂志, 2017, 27(22): 5105-5108.
[29] 孙建明, 董芳. 儿童急性淋巴细胞白血病化疗后的不良反应[J]. 昆明医科大学学报, 2017, 38(10): 107-111.
[30] 周竞奋, 陈琰, 朱振峰, 等. 急性白血病患者医院感染的临床特点分析[J]. 中华医院感染学杂志, 2018, 28(7): 987-990.
[31] 于意. 肿瘤化疗药物应用中不良反应的临床研究[J]. 中国医药指南, 2018, 16(10): 72-73.
[32] Ren, J.H., Lin, Q.X., Chen, W.M., et al. (2019) G-CSF-Primed Haplo-Identical HSCT with Inten-sive Immunosuppressive and Myelosuppressive Treatments Does Not Increase the Risk of Pre-Engraftment Bloodstream Infection: A Multicenter Case Control Study. European Journal of Clinical Microbiology & Infectious Diseases, 38, 865-876. [Google Scholar] [CrossRef] [PubMed]
[33] Marín, M., Gudiol, C., Ardanuy, C., et al. (2015) Factors Influ-encing Mortality in Neutropenic Patients with Haematologic Malignancies or Solid Tumours with Bloodstream Infection. Clinical Microbiology and Infection, 21, 583-590. [Google Scholar] [CrossRef] [PubMed]
[34] 闫晨华, 徐婷, 郑晓云, 等. 中国血液病患者中性粒细胞缺乏伴发热的多中心、前瞻性流行病学研究[J]. 中华血液学杂志, 2016, 37(3): 177-182.
[35] Ustun, C., Young, J.H., Papanicolaou, G.A., et al. (2019) Bacterial Blood Stream Infections (BSIs), Particularly Post- Engraftment BSIs, Are Associated with Increased Mortality after Allogeneic Hematopoietic Cell Transplantation. Bone Marrow Transplantation, 54, 1254-1265. [Google Scholar] [CrossRef] [PubMed]
[36] Kikuchi, M., Akahoshi, Y., Nakano, H., et al. (2015) Risk Factors for Preand Post-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Infectious Disease, 17, 56-65. [Google Scholar] [CrossRef] [PubMed]
[37] Averbuch, D., Orasch, C., Cordonnier, C., et al. (2013) European Guidelines for Empirical Antibacterial Therapy for Febrile Neutropenic Patients in the Era of Growing Resistance: Summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica, 98, 1826-1835. [Google Scholar] [CrossRef] [PubMed]
[38] Zhou, J., Li, M. and Tang, Z. (2014) Peripherally Inserted Cen-tral Catheter: How Safe Is It for Acute Myeloid Leukemia Patients? Medical Principles and Practice, 23, 586. [Google Scholar] [CrossRef] [PubMed]
[39] Casner, M., Hoesli, S.J., Slaughter, J.C., Hill, M. and Weitkamp, J.H. (2014) Incidence of Catheter-Related Bloodstream Infections in Neonates Following Removal of Peripherally Inserted Central Venous Catheters. Pediatric Critical Care Medicine, 15, 42-48. [Google Scholar] [CrossRef
[40] 张家友, 吴亚兵, 陈丽娟, 刘军慧, 韩少玲, 袁军, 叶璐. 血液恶性肿瘤患者致病菌的分布及耐药性分析[J]. 解放军预防医学杂, 2020, 38(11): 89-94
[41] 李书坛, 唐柳, 陈晓敏, 李晓明. 成人急性髓系白血病患者化疗后发生院内感染影响因素及其防治对策研究[J]. 中国实验血液学杂志, 2018(2): 412-416.
[42] 张晓波, 谢佳, 王浩, 等. 重组人粒细胞集落刺激因子联合抗生素治疗急性白血病化疗后中性粒细胞缺乏合并感染患者的临床效果[J]. 临床医学研究与实践, 2019, 4(21): 12-14.
[43] 周燕萍, 杨晓荣, 白海燕, 等. rhG-CSF治疗不同白细胞减少症的疗效与机制[J]. 现代医学, 2016, 44(12): 1762- 1765.
[44] 李月, 张广迎, 蒋引娣, 刘接班, 焦雯静. 血液恶性肿瘤患者化疗后血流感染发生率、病原菌分布情况及其影响因素分析[J]. 癌症进展, 2021, 19(20): 2122-2125.
[45] 王丽萍, 金炎, 邵春红, 等. 2016-2017年医院血流感染病原菌检出情况和报阳时间及主要菌株的耐药性分析[J]. 中国医药, 2019, 14(9): 1415-1419.
[46] 李敏燕, 刘秀婷, 刘彦琴, 等. 急性白血病患者血流感染病原菌分布及耐药性分析[J]. 临床军医杂志, 2018, 46(4): 395-398.
[47] Akinao, O., Yoshinobu, K., Shun-ichi, K., et al. (2021) Predictive and Risk Factor Analysis for Blood-stream Infection in High-Risk Hematological Patients with Febrile Neutropenia: Post-Hocanalysis from a Prospective, Large-Scale Clinical Study. International Journal of Hematology, 114, 472-482. [Google Scholar] [CrossRef] [PubMed]
[48] 如意, 温晋爱, 常学奇, 等. 核工业某研究院职工死亡危险因素的Logistic回归研究[J]. 肿瘤, 2004, 24(3): 213-215.