Objective: To investigate the microbiologic and clinical characteristics of bloodstream infection in neutropenic pediatric patients with hematological malignancies and provide data support for the rational use of antimicrobial agents in these patients. Methods: A retrospective analysis was performed on the clinical data, pathogen species distribution, and drug sensitivity data of bloodstream infection in neutropenic pediatric patients with hematological malignancies from the Institute of Hematology & Blood Diseases Hospital from January 2014 to December 2018. Results: Total 537 episodes of bloodstream infections occurred in 427 neutropenic children with hematological malignancies; the 30-day all-cause mortality rate was 3.7%. The clinical feature of 44.7% patients with bloodstream infection was only fever, and the pathogenic bacteria were mainly enterobacteriaceae bacteria. Bloodstream infection was usually accompanied by oral mucosa (20.7%) , respiratory tract (20.5%) , and digestive tract (14.3%) symptoms. The distribution of pathogens in patients with different symptoms of bloodstream infection varied (χ(2)=40.561, P=0.001) . Total 550 strains of pathogens were isolated, and the top 5 bacteria were Streptococcus aureus (109 strains, 19.8%) , Escherichia coli (99 strains, 18.0%) , Staphylococcus epidermidis (75 strains, 13.6%) , Klebsiella pneumoniae (67 strains, 12.2%) , and Staphylococcus aureus (32 strains, 5.8%) . The resistance rates of Enterobacteriaceae and Pseudomonas aeruginosa to piperacillin/tazobactam and carbapenems were <5%. The proportion of methicillin-resistant Staphylococcus aureus (MRSA) in Staphylococcus aureus was 9.7%. Conclusion: The proportion of pathogenic bacteria gram-positive cocci and gram-negative bacilli in the bloodstream infection of neutropenic children with hematological malignancies was approximately the same, suggesting that the use of antimicrobial agents should be broad-spectrum. Carbapenems, glycopeptides, and enzyme inhibitor complexes still have good effects.
目的： 探讨儿童血液病患者在中性粒细胞缺乏（粒缺）期发生血流感染时的病原学分布、耐药情况，为该类患者合理使用抗菌药物提供数据支持。 方法： 回顾性分析2014年1月至2018年12月中国医学科学院血液病医院收治的儿童血液病患者粒缺期发生血流感染时的临床特征、病原菌分布和药物敏感性数据。 结果： 427例儿童血液病患者在粒缺期共发生537次血流感染，30 d全因死亡率为3.7%。其中44.7%例次血流感染的临床特征仅表现为发热，其病原菌以肠杆菌科细菌为主。血流感染常伴口腔黏膜、呼吸道及消化道症状，比例分别为20.7%、20.5%和14.3%。伴不同症状的血流感染病原菌分布不同（χ(2)=40.561，P=0.001）。共分离出550株病原菌，位于前5位的细菌分别为草绿色链球菌（109株，19.8%）、大肠埃希菌（99株, 18.0%）、表皮葡萄球菌（75株，13.6%）、肺炎克雷伯菌（67株，12.2%）和金黄色葡萄球菌（32株，5.8%）。耐药方面，肠肝菌科细菌及铜绿假单胞菌对于哌拉西林/他唑巴坦、碳青霉烯类药物的耐药率<5%。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的比例为9.7%。 结论： 儿童恶性血液病患者粒缺期发生血流感染病原菌革兰阳性球菌与阴性杆菌比例大致相同，提示经验性抗菌药物使用应具有广谱性，常见分离菌耐药性仍处于较低水平，常用的碳青霉烯类、糖肽类、酶抑制剂复合物类药物如哌拉西林/他唑巴坦等仍具有较好效果。.
Keywords: Bloodstream infection; Drug resistance; Hematological malignancies; Pathogens; Pediatric.