异基因造血干细胞移植患者血流感染病原菌谱及耐药性——单中心回顾性分析

OBJECTIVE: To elucidate the clinical characteristics of bloodstream infection in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in our hospital and improves the survival of transplant patients with bloodstream infection. METHODS: Two hundred and ten patients with allo-HSCT from the Department of Hematology were retrospectively analyzed between October 2014 and September 2019. Pathogen distribution, drug resistance, risk factors, and outcomes were investigated in 49allo-HSCT patients with bloodstream infections. RESULTS: Forty-nine of 210 patients with allo-HSCT had bloodstream infection, and 59 pathogenic microorganisms were identified, mainly Gram-negative bacteria (67.8％), of which E. coli had the highest incidence (23.7％), CRO accounted for 42.5％, and Gram-positive bacteria accounted for 23.7％ (without vancomycin or linezolid-resistant strain). Additionally, fungi accounted for 8.5％. Univariate analysis suggested that the risk factors of bloodstream infection were gender, pretransplant disease status, and conditioning regimen. In contrast, multivariate analysis showed that bloodstream infection was mainly related to conditioning regimens. Further grouping results showed that 77.6％ of patients with neutropenia had bloodstream infections, and 22.4％ of patients with non-neutropenia had bloodstream infections; 81.0％ of patients with active infections before transplantation had bloodstream infections, while bloodstream infection occurred in 16.9％ of patients without active infection. Survival analysis showed that long-term survival of patients with bloodstream infection is shorter than that of patients without bloodstream infection and long-term survival of patients with CRO infection is shorter than that of patients without CRO infection. The survival of patients with neutropenia longer than 14 d is shorter than that of patients with neutropenia shorter than 14 d. Furthermore, there is no correlation between whether there is an active infection before transplantation and whether they are in a neutropenic state at the time of infection and survival. CONCLUSION: Our results suggest that effective prevention of bloodstream infections from drug-resistant bacteria, particularly CRO, shortening the duration of neutropenia, eradication of potential infections before transplantation, and patient-adaptive conditioning could reduce transplant-related mortality and improve prognosis.