Clinical Analysis Of 111 Cases Of Klebsiella Pneumoniae Bloodstream Infection In Patients With Malignant Hematological Diseases

Objective To investigate the incidence and clinical characteristics of Klebsiella pneumoniae bloodstream infection in hematological malignancies.MethodsThe clinical data of patients with malignant hematological diseases complicated with Klebsiella pneumoniae bloodstream infection from January 1,2016 to October 31,2018 in the Department of Hematology of the Hospital were systematically and retrospectively analyzed.Result During the period of October 31,2018,a total of 5,847 strains of klebsiella pneumoniae were isolated in our hospital.The main sources of the specimens were 2,688 strains of sputum(46.0%),916 strains of blood(15.7%)and 766 strains of midcourseurine(13.1%).The top three sources of specimens in the department were 1181 strains from The department of cardiac surgery(including Intensive Care Unit of department of cardiac surgery),896 strains from Intensive Care Unit,and 778 strains from The Hematology Department.The 778 strains of klebsiella pneumoniae were isolated from The Hematology Department,and the samples were 368 strains of blood(47.3%),181 strains of sputum(23.3%),63 strains of swab(8.1%),44 strains of perianal swab(5.7%),43 strains of midcourse urine(5.5%),etc..The proportion of blood source of strains isolated from The Hematology Department was higher than that of non-Hematology Department in the hospital,and the difference was statistically significant(P < 0.05).A total of 111 patients with hematological malignancies complicated with Klebsiella pneumoniae bloodstream infection were included,including 21 patients(18.9%)producing extended-spectrum β-lactamases(ESBLs)Klebsiella pneumoniae,and carbapenem-resistant enterobacteriaceae bacteria(CRE)31 ca ses(27.9%)and 31 cases(27.9%)were multidrug resistant bacteria(MDR).44 of 111 patients died,with a mortality rate of 39.6%.The occurrence of multidrug-resistant Klebsiella pneumoniae bloodstream infection is related to antibiotic exposure before infection and albumin level.Patients with hematological malignancies with antibiotic exposure before infection and low albumin level are more prone to multi-drug resistant bacteria infection.The increased risk of death in patients with Klebsiella pneumoniae bloodstream infection is related to multi-drug resistant bacteria infection,basic diseases,other pathogen infection,procalcitonin level,albumin level and correct anti-infection treatment.Patients with multi-drug resistant bacteria infection,infection with other pathogens,higher procalcitonin level,lower albumin level and Incorrect anti-infection treatment plan have greater risk of death.Conclusion The mortality rate of Klebsiella pneumoniae bloodstream infection in patients with malignant hematological diseases is high.The low level of serum albumin and antibiotic exposure before infection are related to the production of multidrug-resistant bacteria.Multiple drug-resistant bacteria infection,combined with underlying diseases,combined with other pathogen infection,high procalcitonin level and low albumin level are associated with increased mortality of patients.Reasonable anti-infection treatment is related to the reduction of patient mortality.