抗感染疗程对急性髓系白血病患者巩固化疗期伴发革兰阴性菌血流感染转归的影响
Impact of duration of antibiotic therapy on the prognosis of patients with acute myeloid leukemia who had Gram-negative bloodstream infection in consolidation chemotherapy
目的 分析巩固化疗期间伴发革兰阴性菌(G-菌)血流感染的急性髓系白血病(AML)患者抗感染疗程对感染转归的影响.方法 回顾性分析2010年9月至2016年1月入组“依据危险度分层对急性髓系白血病优化治疗的研究”临床试验的591例AML(非急性早幼粒细胞白血病)患者的血流感染资料,将其中巩固化疗期间发生G-菌血流感染且持续发热时间<7d的114例次血流感染(89例患者)纳入研究,分析抗感染疗程对感染转归的影响.结果 114例次血流感染发生时,患者中位ANC为0(0~5.62)×109/L,中性粒细胞缺乏(粒缺)持续的中位时间为9(3~26)d,抗感染治疗的中位时间为7(4~14)d.抗感染疗程≤7 d与>7d组比较,停药后3d内再发热比例、再次发生相同菌株血流感染比例分别为1.2%对3.0%、18.5%对21.2%,差异均无统计学意义(P=0.522,OR=0.400,95%CI0.024 ~ 6.591;P=0.741,OR=0.844,95%CI 0.309~ 2.307).同时,两组患者均未发生7d及30 d内感染相关死亡.且倾向性评分平衡患者特征及用药差异因素后,抗感染疗程≤7 d较>7d组再次发生相同菌株血流感染比例仍无明显增高(P=0.525,OR=0.663,95%CI 0.187~ 2.352).结论 对于巩固化疗期间伴发G-菌血流感染的AML患者,若发热时间<7d,敏感抗菌药物治疗7d后停药并不增加停药后3d内再发热,粒缺期再次出现相同菌株血流感染及感染相关7d、30 d内死亡风险.提示短疗程抗感染方案可以成为巩固化疗伴发G-菌血流感染AML患者感染控制情况下合理的治疗选择.
更多Objectives To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy.Methods Data were collected retrospectively from 591 patients enrolled from the registered "A Phase Ⅲ study on optimizing treatment based on risk stratification for acute myeloid leukemia,ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles.Results A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy.Excluding the 5 episodes in which fever lasted longer than 7 days,114 episodes of infection were analyzed.The median neutrophil count was 0 (0-5.62)× 109/L,median neutropenia duration was 9 (3-26) days,median interval of antibiotics administration was 7 (4-14) days.Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or > 7 days (1.2% vs 3.0%,P =0.522,OR =0.400,95% CI0.024-6.591;18.5% vs 21.2%,P =0.741,OR =0.844,95% CI 0.309-2.307).Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or > 7 days (P=0.525,OR=0.663,95% CI 0.187-2.352).No infection associated death occurred within 7 or 30 days in both groups.Conclusion Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate.Indicating that,for AML who had Gram-negative bloodstream infection during consolidation chemotherapy,short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.
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