Analysis of the etiological characteristics and optimized anti-infection regimens for infections during the bone marrow suppression period after chemotherapy in patients with hematological diseases
血液病患者化疗后骨髓抑制期感染的病原学特点及抗感染优化方案分析

摘要

目的 探讨血液病患者在化疗导致的骨髓抑制阶段发生感染的病原谱、耐药情况及其相关影响因素，为基层医疗机构制定更合理的抗感染方案提供依据。方法 回顾性整理本院2020年1月至2024年12月间80例化疗后粒细胞减少并发感染的病例，完成病原菌鉴定及药敏分析，并通过倾向评分匹配与多因素Logistic回归评估感染危险因素。同时采用限制性立方样条（Restricted Cubic Spline, RCS）模型分析降钙素原（Procalcitonin, PCT）与感染严重程度的关系。结果 本组共检出病原菌102株，以革兰阴性菌为主（67.65%），主要包括肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌；革兰阳性菌占27.45%，真菌占4.90%。ESBLs产酶菌比例偏高，铜绿假单胞菌对碳青霉烯类的耐药率为21.43%。分析显示，中性粒细胞缺乏持续≥7 d、留置中心静脉导管以及碳青霉烯类药物使用均为感染的独立危险因素（P＜0.05）。RCS曲线提示PCT随感染严重程度升高呈明显的非线性上升趋势。结论 本院化疗后骨髓抑制期患者的感染以革兰阴性菌为主要病原，耐药形势严峻；结合区域病原学特点及危险因素构建的抗感染管理策略，有助于提升基层医院的感染处置能力与治疗效果。

Abstract

Objective To investigate the pathogen distribution, antimicrobial resistance patterns, and risk factors of infections occurring during chemotherapy-induced myelosuppression in patients with hematologic diseases, and to provide evidence for optimizing anti-infective strategies in primary hospitals.
Methods Clinical data of 80 patients with infection after chemotherapy-related myelosuppression (2020-2024) were retrospectively analyzed. Pathogens were identified and drug susceptibility was tested. Propensity score matching (PSM) and multivariate logistic regression were used to assess independent risk factors. Restricted cubic spline (RCS) model was also adopted to analyze the relationship between procalcitonin (PCT) and the severity of infection.
Results A total of 102 pathogens were isolated: 67.65% were Gram-negative bacteria (mainly Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa), 27.45% Gram-positive bacteria, and 4.90% fungi. ESBL-producing strains were common, and P. aeruginosa showed 21.43% carbapenem resistance. Neutropenia ≥7 days, central venous catheterization, and carbapenem use were independent risk factors (P<0.05). PCT levels were nonlinearly associated with infection severity.
Conclusion   Gram-negative bacteria predominate in infections during myelosuppression, with notable resistance patterns. Anti-infective strategies based on local epidemiology and risk factors may improve clinical outcomes in primary hospitals.