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目的:探讨重型再生障碍性贫血(SAA)患者并发感染的临床特征,以指导治疗。方法:回顾性分析50例SAA患者,总结SAA所并发感染的特点。结果:SAA患者并发感染的患病率为100%。粒细胞缺乏(粒缺)时间越长,容易并发感染的部位数越多(P=0.034)。感染好发部位最常见的是肺部和上呼吸道,其次为口腔,皮肤软组织,血流,胃肠道,泌尿系等。肺感染与年龄相关(P=0.026),血流感染与粒缺持续时间相关(P=0.032)。感染部位取得标本培养结果以革兰阴性细菌为主,占68.9%,革兰阳性细菌占27.3%,真菌占3.8%。革兰阳性细菌中最常见的是凝固酶阴性葡萄球菌。革兰阴性细菌中最常见的依次为铜绿假单胞菌,肺炎克雷伯杆菌,阴沟肠杆菌,鲍曼不动杆菌,嗜麦芽窄食单胞菌,大肠埃希菌。血培养中最常见的是肠杆菌科,凝固酶阴性的葡萄球菌,痰培养中最常见的依次是非发酵菌,肠杆菌科。50例患者中,19例(38%)合并有病毒感染,最常见的是单纯疱疹。1例患者合并肺结核,症状体征均不典型。粒缺时间越长,感染持续时间越长。SAA并发感染患者好转27例,自动出院18例,死亡5例。血流感染组病死率高于无血流感染组(P=0.004)。结论:SAA患者是感染的高危人群。经验性治疗必须覆盖革兰阴性细菌。同时应积极促进中性粒细胞水平恢复,缩短粒缺时间,以达到控制感染,提高疗效,减少死亡率的目的。
Objective: To investigate the clinical characteristics of complicated infection in patients with severe aplastic anemia (SAA) to guide the treatment. Methods: A retrospective analysis of 50 cases of SAA patients, summarize the characteristics of SAA complicated by infection. Results: The prevalence of concurrent infections in SAA patients was 100%. The longer the agranulocytosis (neutropenia), the more prone to complicated infection (P = 0.034). The most common sites of infection are the lungs and the upper respiratory tract, followed by the mouth, skin and soft tissue, bloodstream, gastrointestinal tract, urinary tract and so on. Lung infection was age-related (P = 0.026), and bloodstream infection was associated with duration of granuloma (P = 0.032). Gram-negative bacteria were predominant in the infected area, accounting for 68.9%, Gram-positive bacteria accounting for 27.3% and fungi accounting for 3.8%. The most common gram-positive bacteria are coagulase-negative staphylococci. The most common gram-negative bacteria followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii, Stenotrophomonas maltophilia, Escherichia coli. The most common blood culture is Enterobacteriaceae, coagulase-negative Staphylococcus aureus, sputum culture followed by non-fermenting bacteria, Enterobacteriaceae. Of the 50 patients, 19 (38%) had a viral infection, the most common being herpes simplex. One patient had pulmonary tuberculosis and the symptoms and signs were not typical. Lack of grain longer, the longer the duration of infection. SAA complicated infection in 27 patients improved, 18 patients were discharged automatically, 5 patients died. The mortality rate of bloodstream infection group was higher than that of no bloodstream infection group (P = 0.004). Conclusion: SAA patients are at high risk of infection. Experienced treatment must cover Gram-negative bacteria. At the same time, we should actively promote the recovery of neutrophil levels and shorten the time of graying, so as to achieve the goal of controlling infection, improving curative effect and reducing mortality.