Tình hình nhiễm trùng huyết trên người bệnh ghép tế bào gốc đồng loài tại bệnh viện Truyền máu Huyết học năm 2023=Bloodstream infections following allogeneic hematopoietic stem cell transplantation in Blood Transfusion Hematology hospital in 2023

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Tác giả: Nghĩa Huỳnh, Văn Mẫn Huỳnh, Nguyễn Hiếu Hạnh Lê, Hạnh Thư Nguyễn, Thế Quang Nguyễn, Chí Dũng Phù

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.484-492

Bộ sưu tập: Metadata

ID: 478312

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Allogeneic hematopoietic stem cell transplantation (alloHSCT) is currently the most common and effective treatment for patients with high-risk hematologic malignancies. However, allogeneic stem cell transplants are complex treatments that carry a significant risk of serious complications, including bloodstream infection (BSI). Our study aimed to investigate the incidence, pathogenic spectrum, timing and risk factors for BSI within 100 days after receiving alloHSCT in our hospital in 2023
in order to optimize the empiric antibiotic therapy and reduce the mortality rate. Objectives: Investigating the incidence, microbiological characteristics and risk factors for BSI within 100 days following allogeneic HSCT. Methods: This observational retrospective study comprised of 38 patients who underwent allogeneic HSCT at Blood Transfusion Hematology Hospital from January 2023 to December 2023. Results: Of the 38 patients, 15 (39.5%) had at least one episode of BSI within 100 days after transplantation. BSI was more often diagnosed during the pre-engraftment phase. Gram-negative bacteria were the most prevalent microorganisms isolated until day 100 post-transplatation (63.2%). Klebsiella pneumoniae was the most common multidrug resistant Gram-negative bacteria (MDRGNB) causing BSI, with Class D Carbapenemase Producer as the main resistance mechanism. The median duration of intravenous antibiotic treatment for BSI patients was 21 days and the overall success rate was 86.7%. In addition, our study demonstrated that PTCybased GVHD prophylaxis was associated with BSI following allogeneic stem cell transplantation. Conclusions: Bloodstream infection is a common and serious complication in patients undergoing allogeneic stem cell transplantation. Providing data on the incidence, timing and the microbiological etiology of BSIs aims to support the clinicians to build appropriate empirical antimicrobial therapy to reduce BSI associated mortality.Xác định tỷ lệ nhiễm trùng huyết, mô tả đặc điểm lâm sàng, vi sinh, các yếu tố nguy cơ liên quan đến nhiễm trùng huyết trong vòng 100 ngày sau ghép tế bào gốc đồng loài tại Bệnh viện Truyền máu Huyết học năm 2023. Phương pháp nghiên cứu: Nghiên cứu hồi cứu, mô tả hàng loạt ca với 38 người bệnh được ghép tế bào gốc đồng loài tại Bệnh viện Truyền máu Huyết học từ 01/2023 đến 12/2023. Kết quả: Trong tổng số 38 người bệnh, 15 (39,5%) người bệnh có ít nhất một đợt nhiễm trùng huyết (BSI) trong vòng 100 ngày sau ghép. Phần lớn nhiễm trùng huyết xảy ra ở giai đoạn trước mọc mảnh ghép. Vi khuẩn Gram âm là tác nhân phân lập được nhiều nhất, chiếm tỷ lệ 63,2%. Vi khuẩn Gram âm đa kháng phổ biến nhất là Klebsiella pneumonia với cơ chế đề kháng chính là Class D Carbapenem Producer. Tỷ lệ điều trị nhiễm trùng huyết thành công 86,7% với thời gian sử dụng kháng sinh tĩnh mạch trung vị là 21 ngày. Ngoài ra, nghiên cứu của chúng tôi cũng cho thấy sử dụng post- Cyclophosphamide (PTCy) trong ghép tế bào gốc nửa thuận hợp để dự phòng bệnh lý mảnh ghép chống ký chủ (GVHD) là yếu tố nguy cơ liên quan đến nhiễm trùng huyết sau ghép. Kết luận: Nhiễm trùng huyết là một biến chứng phổ biến và nghiêm trọng sau ghép tế bào gốc tạo máu đồng loài. Phân tích đặc điểm nhiễm trùng huyết và các tác nhân gây bệnh giúp các nhà lâm sàng xây dựng phác đồ kháng sinh kinh nghiệm phù hợp, góp phần làm giảm tỷ lệ tử vong.

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