Analysis of the distribution of pathogenic bacteria and risk factors for sepsis shock in hematologic malignancies with bloodstream infection
Objective To analyze the distribution of pathogenic bacteria in bloodstream infections(BSI)in pa-tients with hematologic malignancies in our hospital and the risk factors for sepsis shock.Methods The case data of 223 patients with malignant hematologic disease treated in the Department of Hematology of the Affiliated Hos-pital of Zunyi Medical University from 2016 to 2023 were collected.The patients were divided into sepsis shock and non-sepsis shock groups based on sepsis shock occurred after bloodstream infection.The primary disease type,clinical manifestation,pathogenic bacteria and drug sensitivity results,duration of neutropenia,rational use of antibiotics,multi-drug resistance,history of using broad-spectrum antibiotics,and other related indicators were collected for correlation analysis.Logistic regression was used to analyze the related factors of BSI compli-cated with sepsis shock in patients with malignant hematologic disease.Results 238 strains of pathogenic bacteria were cultured from 223 patients with bloodstream infections.142 strains(59.70％)were Gram-negative bacteri-a,including 25 strains of Klebsiella pneumoniae and 75 strains of Escherichia coli;93 strains(39％)were Gram-positive bacteria,including 28 strains of Staphylococcus aureus,22 strains of Staphylococcus epidermidis,and 9 strains of Staphylococcus aureus;3 strains(1.30％)were Fungi,including Candida tropicalis,Candida parapsilosis,and Candida krusei.Among the 223 cases of hematologic disease with bloodstream infections,25 cases developed sepsis shock and 16 cases died(64％).Univariate analysis showed that there were differences between the sepsis shock and non-sepsis shock groups in the period of granulocytopenia(P＜0.001),reasonable use of antibiotics(P=0.007),multidrug resistance(P=0.017),combined cardiac insufficiency(P=0.018),and renal insufficiency(P＜0.001).Multivariate analysis showed that the duration of granulocytopenia≥7 days(OR=3.306,P=0.008),unreasonable use of antibiotics(OR=2.612,P=0.004),cardiac insuf-ficiency(OR=6.291,P=0.008),and acute renal insufficiency(OR=8.419,P=0.002)were independent risk factors for infectious shock in patients with hematologic malignancies.Conclusion The main pathogenic bac-teria in hematologic malignancies with BSI are Gram-negative bacteria.Measures to reduce sepsis shock in hema-tologic malignancies with bloodstream infections include shortening the period of granulocytopenia,early and ra-tional use of antibiotics,and correcting cardiac and renal insufficiency.
hematologic malignancybloodstream infectiondistribution of pathogenic bacteriasepsis shockrisk factors
万方数据
维普
