OBJECTIVE To analyze the clinical characteristics of bloodstream infection (BSI) in patients treated by hematopoietic stem cell transplantation (HSCT). METHODS The clinical characteristics, distribution of pathogenic bacteria causing BSI and drug sensitivity of 910 patients treated by HSCT in our department from January 2013 to June 2020 were retrospectively analyzed. RESULTS Among 910 HSCT patients, 111 patients were diagnosed as BSI within 100 days after transplantation, and 98 patients showed BSI during the period of agranulocytosis. Multivariate analysis showed that the usage of anti-thymocyte globulin (ATG), long duration of agranulocytosis and low infusion volume of mononuclear cell (MNC) were the independent risk factors affecting BSI after HSCT. Among 121 pathogenic bacteria isolated, 76 Gram-negative (G-) bacteria (62.8%), 40 Gram-positive (G+) bacteria (33.0%), and 5 fungi (4.1%) were detected out. The top three pathogens were Escherichia coli, Staphylococcus epidermidis and Pseudomonas aeruginosa. The drug-resistance rates of Escherichia coli and Klebsiella pneumoniae to carbapenems was 14.3% and 7.7%, respectively, and Pseudomonas aeruginosa was 66.7%. The susceptibility of G+ bacteria to vancomycin, linezolid and teicoplanin was 97.5%, 100% and 100%, respectively. The crude mortality rate of the patients with BSI at 100 days after HSCT was significantly higher than that of patients without BSI (P<0.001). CONCLUSION The usage of ATG, long duration of agranulocytosis and low infusion volume of MNC are independent risk factors for BSI after HSCT. The pathogens after HSCT are mainly G- bacteria. Pseudomonas aeruginosa is highly resistant to carbapenems. Key words　　;

目的 总结血液病并发革兰阳性菌血流感染患者的临床特点,并分析接受规律治疗的患者的预后影响因素.方法 回顾性分析164例合并革兰阳性菌血流感染的血液病患者的临床资料,按照细菌分离培养时间将病例及其检出病原菌分为A组(2012年6月至2016年5月)及B组(2016年6月至2020年5月).总结两组病原菌的分布和耐药情况、患者的抗菌治疗情况及临床结局.分析接受规律治疗的血液病患者并发革兰阳性菌血流感染后30 d内死亡的影响因素,并评估相关因素预测患者预后的效能.结果 (1)共检出革兰阳性菌172株,包括168株球菌和4株杆菌,检出率位列前四的病原菌依次为凝固酶阴性葡萄球菌、草绿色链球菌、金黄色葡萄球菌及肠球菌.B组的金黄色葡萄球菌检出率高于A组(P<0.05),而两组其他病原体的检出率差异无统计学意义(均P>0.05).(2)耐甲氧西林凝固酶阴性葡萄球菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌总检出率分别为83.9％(73/87)、53.8％(14/26)及6.7％(1/15).凝固酶阴性葡萄球菌、金黄色葡萄球菌、草绿色链球菌、肠球菌对万古霉素、替考拉宁、利奈唑胺及替加环素敏感率为93.3％ ～100.0％.(3)初始应用糖肽类抗生素或利奈唑胺者抗生素调整率仅为16.9％,低于初始未应用糖肽类抗生素或利奈唑胺者的62.2％(P<0.05).接受规律治疗的血液病患者并发革兰阳性菌血流感染后30 d内病死率为12.2％.(4)高龄、合并感染性休克、肠球菌血流感染及血流感染当天血清白蛋白<30 g/L是血液病并发革兰阳性菌血流感染患者接受规律治疗后30 d内死亡的独立危险因素(均P<0.05).将4个危险因素作为综合指标,预测血液病并发革兰阳性菌血流感染患者规律治疗后30 d内死亡的曲线下面积为0.943,优于单一危险因素预测的曲线下面积(P<0.05).结论 血液病患者并发革兰阳性菌血流感染时以凝固酶阴性葡萄球菌为主,金黄色葡萄球菌检出率有上升趋势;在完善血培养的同时,早期可经验性应用糖肽类抗生素、利奈唑胺等进行治疗.应重视高龄、合并肠球菌血流感染、感染性休克及血流感染当天血清白蛋白<30 g/L的患者,规律治疗的同时须密切、动态观察病情,以降低病死率.