[Clinical Features of Infection within 100 days after Hematopoietic Stem Cell Transplantation in 313 patients with Hematologic Diseases].

ABSTRACT

OBJECTIVE: To analyze the clinical characteristics of infection within 100 days after hematopoietic stem cell transplantation (HSCT) in patients with hematologic disease. METHODS: The culture results of 313 HSCT patients infected in the hematology department of our hospital from January 2013 to January 2019 were collected, and the infection incidence, pathogen distribution, drug susceptibility test results and infection risk factors out of them all were analyzed. RESULTS: Among 313 HSCT patients, infection occurred within 100 days in 262(83.7%) patients, 234 (89.3%) cases were in neutropenic period at infection onset. 156 pathogen distributions showed that the bloodstream infection (64.1%) ranked first. Among isolates, Gram-negative bacteria was 86 (55.1%), which were higher than Gram-positive bacteria (49, 31.4%), and fungi was 21(13.5%). The prevalence of ESBLs in E.coli and Klebsiella pneumoniae were 36.4% and 31.6%, respectively. The drug resistance rates of E.coli and Klebsiella pneumoniae to carbapenems were 18.20% and 5.3%, respectively, and to amikacin were 29.5% and 10.5%, respectively. The antimicrobial resistance of fermentation bacteria was significantly different. The drug resistence rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems were high. Only one strain of methicillin-resistant staphylococcus aureus (MRSA) was found. The drug resistence rates of enterococcus faecalis to linezolid was 14.30%. The sensitivity of other Gram-positive bacteria to vancomycin, teicolanin and linezolid was 100%. The HSCT in our hospital was mainly allogeneic, and univariate analysis showed that the risk factors for infection were status before trasplantion, HLA matching type,length of stay for the first transplant, and length of neutropenia, while Mulvariate analysis showed that only HLA matching type showed statistical significance. CONCLUSION: The infection of patients after HSCT occurrs in period of neutropenia, Most of pathogens are G- bacteria, and the resistance to antibiotics is quite common, HLA mismatch is allo-HSCT independent risk factors for infection. It is very imprtant to monitor actively the distribution of pathogenic bacteria, drug-resistance and risk factors of infection for guiding more reasonable and standardized clinical treatment.