免疫抑制治疗后合并血流感染的重型再生障碍性贫血患者临床特征及预后分析

OBJECTIVE: To assess the clinical feature and outcomes of severe aplastic anemia (SAA) patients suffered from bacteremia following antithymocyte globulin (ATG). METHODS: A total of 264 cases hospitalized in our hospital between Jan 2000 and July 2011 were enrolled into this study. We evaluated the associated pathogens of bacteremia, analyzed the risk factors by Logistic regression and estimated the overall survival (OS) by Kaplan-Meier method for the cohort of patients. RESULTS: Bloodstream infections occurred in 49 patients, with a median age of 20 (4–62) years, including 38 cases with very SAA (VSAA) and 11 SAA patients. The median time of bacteremia was 13 (2–233) days following ATG administration. The most common microbiologically were Enterobacteriaceae (28.4%), Pseudomonas aeruginosa (20.9%) and Klebsiella pneumonia (14.9%). Almost half (46.9%) of these bacteria were resistant to most or all available antibacterial classes. Univariate and multivariate analyses demonstrated that VSAA, infections during previous week before ATG treatment were risk factors for bacteremia. The 3 and 6 months response rates (10.6% and 17.0%) were poor in the patients with bloodstream infections, which were significantly lower than those patients without infections (35.6% and 55.6%, respectively, both P<0.001). The estimated 5-year OS were 36.4% (95%CI 21.3% to 51.5%) and 74.5% (95%CI 68.4% to 80.7%) in the two groups, respectively (P<0.001). CONCLUSION: ①VSAA has higher risk of bacteremia than SAA; ②Infections during previous week before ATG administration was a risk factor for bacteremia; ③The outcomes of SAA or VSAA patients suffered from bacteremia following ATG was poor.