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OBJECTIVE@#To analyze the distribution and drug resistance of pathogens in oral mucositis associated with chemotherapy in hospitalized patients with malignant hematopathy, so as to provide scientific evidences for rational selection of antibiotics and infection prevention and control.@*METHODS@#From July 2020 to June 2022, 167 patients with malignant hematopathy were treated with chemical drugs in the Department of Hematology, Hainan Hospital, and secretions from oral mucosal infected wounds were collected. VITEK2 COMPECT automatic microbial identification system (BioMerieux, France) and bacterial susceptibility card (BioMerieux) were used for bacterial identification and drug susceptibility tests.@*RESULTS@#A total of 352 strains of pathogens were isolated from 167 patients, among which 220 strains of Gram-positive bacteria, 118 strains of Gram-negative bacteria and 14 strains of fungi, accounted for 62.50%, 33.52% and 3.98%, respectively. The Gram-positive bacteria was mainly Staphylococcus and Streptococcus, while Gram-negative bacteria was mainly Klebsiella and Proteus. The resistance of main Gram-positive bacteria to vancomycin, ciprofloxacin and gentamicin was low, and the resistance to penicillin, cefuroxime, ampicillin, cefotaxime, erythromycin and levofloxacin was high. The main Gram-negative bacteria had low resistance to gentamicin, imipenem and penicillin, but high resistance to levofloxacin, cefotaxime, cefuroxime, ampicillin and vancomycin. The clinical data of oral mucositis patients with oral ulcer (severe) and without oral ulcer (mild) were compared, and it was found that there were statistically significant differences in poor oral hygiene, diabetes, sleep duration less than 8 hours per night between two groups (P<0.05).@*CONCLUSION@#Gram-positive bacteria is the main pathogen of oral mucositis in patients with malignant hematopathy after chemotherapy. It is sensitive to glycopeptide antibiotics and aminoglycosides antibiotics. Poor oral hygiene, diabetes and sleep duration less than 8 hours per night are risk factors for oral mucositis with oral ulcer (severe).
Subject(s)
Humans , Vancomycin/therapeutic use , Cefuroxime , Levofloxacin , Oral Ulcer/drug therapy , Drug Resistance, Bacterial , Anti-Bacterial Agents/adverse effects , Ampicillin , Penicillins , Cefotaxime , Gram-Positive Bacteria , Gram-Negative Bacteria , Gentamicins , Stomatitis/drug therapyABSTRACT
Objective To analyze the pathogenesis and clinical characteristics of blood stream infection (BSI) occurring after chemotherapy in elderly patients with hematological malignancies hospitalized in this hospital, and to evaluate the role of procalcitonin (PCT) level in judging the pathogenic type of bacteria in BSI. Methods Thirty-nine elderly patients with malignant hematopathy were admitted to the Department of Hematologic Oncology of Shanxi Province Coal Center Hospital from June 2015 to June 2017, after admission they were treated with chemotherapy, then they were complicated with blood stream infection, and their clinical data were retrospectively analyzed; the clinical efficacy, the pathogenic factor of BSI occurring during chemotherapy, infection sites, pathogenesis, the different levels of PCT of bacterial types in BSI, etc. were observed. Results Thirty-nine cases of BSI were all in the stage of agranulocytosis, the proportion of relapsed and refractory re-induction remission chemotherapy was significantly higher than that of initial induction remission and consolidation intensive therapy [51.3% (20/39) vs. 28.2% (11/39), 20.5% (8/39)]. The BSI in 29 patients was controlled and 10 cases with BSI were dead. Clear infection sites sequences were respiratory tract (37 case times), digestive tract (25 case times) and anus periphery (10 case times); 39 pathogenic strains were isolated from the blood cultures, including the gram positive (G+) bacteria accounting for 43.6% (17/39), gram negative (G-) bacteria 53.8% (21/39) and fungi 2.6% (1/39). At the high level of PCT, the detection rate of G- bacteria was high, the PCT levels of isolated G- bacteria such as Escherichia coli, Aerobacter cloacae, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter bauman from high to low in turn were 12.82 (9.91 - 15.73), 10.19 (7.17 - 12.21), 10.01 (7.85 - 12.28), 9.68 (7.95 - 11.41), 8.12 (7.12 - 9.12) μg/L respectively; at the low level of PCT, the detection rate of G+bacteria was high, PCT levels of isolated G+bacteria such as methicillin-resistant Staphylococcus aureus, Enterococcus faecium, Streptococcus pneumoniae, Hemolytic streptococcus from high to low in turn were 6.87 (4.12 - 9.62), 2.78 (2.17 - 3.39), 1.31 (0.42 - 2.20), 1.05 (0.39 - 1.71) μg/L respectively. The positive predictive value of PCT for the diagnosis of G- bacterial BSI was higher than that for the G+bacterial BSI (90.1% vs. 78.3%). Conclusions In elderly patients with hematological malignancies, after chemotherapy, they are accompanied by BSI that is closely related to granulocyte count; PCT level has a suggestive effect on different types of bacteria as pathogen of BSI and the high level of PCT indicates a greater possibility that the BSI is due to G- bacterial infection.
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Objective To investigate the clinic and microbial characteristic of fever along with agranulocy-tosis in patients with malignant hematopathy. Methods Retrospective study was carried out on patients with malig-nant hematopathy who developed agranulocytosis during hospitalization. Results A total of 512 febrile events occurred. Duration of agranulocytosis,severe agranulocytosis,poor physical condition,previous exposure to broad-spectium antibiotics and central venous catheterization were correlated with higher incidence of febrile event. There are 328 cases(64.06%)with definite infected sites and 184 cases(35.94%)with fever of unknown origin(FUO). Gram-negative bacterium was most common(64.35%),followed by Gram-positive bacterium(23.61%)and fungus (12.04%). 57 cases resistant bacteria were detected. Mortality incidence resulting from pulmonary infection was higher than that from FUO(P 0.25)or between blood stream infection and FUO(P>0.1). Conclusions Many factors were corre-lated with incidence of fever along with agranulocytosis in patients with malignant hematopathy. Gram-negative bacte-rium was most common pathogenic microorganism,followed by Gram-positive bacterium,all of which manifested high drug resistance rate. Understanding the epidemiological trend will be beneficial for clinic treatment.
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Objective To evaluate the effect of class 10000 laminar flow ward on the incidence of healthcare-asso-ciated infection (HAI)in patients with initial occurrence of acute leukemia during induction chemotherapy period. Methods Patients with initial occurrence of acute leukemia admitted to a hematological department of a hospital be-tween October 2013 and June 2014 were investigated retrospectively,patients in class 10000 laminar flow ward was as trial group,in general ward was as control group. All patients received standard induction chemotherapy and the same nursing measures,the incidence of HAI between two groups of patients,and ward air cleanliness were com-pared.Results A total of 79 patients with initial acute leukemia were received (trial group,n= 39;control group, n= 40). The average air cleanliness value in rooms and corridors of laminar flow wards were both significantly dif-ferent with general ward (3.57×106/m3 vs 149.36×106/m3 ,t= 45.80,P<0.001;24.46×106/m3 vs 15854.38 ×106/m3 ,t= 108.70,P<0.001). Incidence of HAI between trial group and control group was significantly differ-ent (23.08% [9/39]vs 45.00% [18/40],χ2= 4.219,P= 0.040). The main infection site in trial group was gastro-intestinal tract (n= 5 ),in control group was lower respiratory tract (n= 8 ). The duration of fever,duration and cost of antimicrobial use in trial group were (6.20±2.10)d,(9.35±2.12)d,and (27113.79±1559.03)yuan re-spectively,in control group were (10.20±2.90)d,(14.15±3.14)d,and (58566.29±2217.54)yuan respectively, difference in duration of fever and cost of antimicrobial use between two groups were all significant(t= 1.021, 1377.45,both P<0.05).Conclusion Laminar flow ward can reduce the incidence of HAI in patients with initial occurrence of acute leukemia,and decrease cost of antimicrobial use.
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OBJECTIVE To investigate the nosocomial infection and risk factors of extended spectrum beta-lactamases (ESBLs),and the concomitant infection with other bacteria and double infection in patients of malignant hematopathy.METHODS Forty six malignant hematopathy patients with nosocomial infection by ESBLs positive bacteria were studied retrospectively.RESULTS ESBLs positive bacteria of nosocomial infection in patients of malignant hematopathy were Escherichia coli and Klebsiella.67.4% Were pulmonary infection and 30.4% with septicemia.Major risk factors were the usage of the third generation cephalosporin,the usage of chemotherapy and adrenal cortical hormone,and agranulocytosis.41.3% Cases had infection with other bacteria and 13.0% cases had double infection at the same time.All cases were sensitive to carbopenems,35.7% cases were sensitive to amikacin.CONCLUSIONS The prognosis of patients with nosocomial infection by ESBLs positive bacteria is bad.It is important to select appropriate chemotherapy,measure granulocyte amount in time,control the use of third generation cephalosporin and intensify support therapy.
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Objective To find a safe and effective way for the collection of stem cells from peripheral blood in low body weight children. Methods Peripheral blood stem cells were collected altogether 15 times in 5 children with body weight lower than 20 kg. One day before the collection, a double cavity tube specially made for children was inserted into femoral vein and remained there for future use. Peripheral blood stem cells were separated by the separation vessel specially designed for children and collected in the collecting tank for children. After initialization, alien blood irradiated by X ray was infused in and moved through the separation machine to keep the blood balanced and hematocrit stable in the body of children. During the separation, anticoagulant/whole blood was kept between 1∶11 and 1∶13. The volume of blood processed every time was 2-4 times of total volume of child blood(2 700-5 850 ml). Results Mononuclear cells and CD34 + cells were successfully collected each time in all 5 children, enough for the transplantation of peripheral blood stem cells. Conclusion The way we developed to collect peripheral blood stem cells in children with low body weight is safe and effective.