Objective: To study the incidence of bloodstream infections, pathogen distribution, and antibiotic resistance profile in patients with hematological malignancies. Methods: From January 2018 to December 2021, we retrospectively analyzed the clinical characteristics, pathogen distribution, and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology, Nanfang Hospital, Southern Medical University. Results: A total of 582 incidences of bloodstream infections occurred in 22,717 inpatients. From 2018 to 2021, the incidence rates of bloodstream infections were 2.79%, 2.99%, 2.79%, and 2.02%, respectively. Five hundred ninety-nine types of bacteria were recovered from blood cultures, with 487 (81.3%) gram-negative bacteria, such as Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. Eighty-one (13.5%) were gram-positive bacteria, primarily Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecium, whereas the remaining 31 (5.2%) were fungi. Enterobacteriaceae resistance to carbapenems, piperacillin/tazobactam, cefoperazone sodium/sulbactam, and tigecycline were 11.0%, 15.3%, 15.4%, and 3.3%, with a descending trend year on year. Non-fermenters tolerated piperacillin/tazobactam, cefoperazone sodium/sulbactam, and quinolones at 29.6%, 13.3%, and 21.7%, respectively. However, only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics. Conclusions: Bloodstream pathogens in hematological malignancies were broadly dispersed, most of which were gram-negative bacteria. Antibiotic resistance rates vary greatly between species. Our research serves as a valuable resource for the selection of empirical antibiotics.目的： 探讨恶性血液病患者血流感染的发生率、病原菌分布及耐药情况，为临床合理使用抗菌药物提供参考。 方法： 回顾性分析2018年1月至2021年12月南方医科大学南方医院血液科收治的恶性血液病合并血流感染患者的临床资料、病原菌分布及耐药性情况。 结果： 4年内22 717例次患者共发生582次血流感染，2018-2021年血流感染的发生率依次为2.79%、2.99%、2.79%和2.02%。共分离出599株病原菌，革兰阴性菌487株（81.3%），主要为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌；革兰阳性菌81株（13.5%），主要为金黄色葡萄球菌、表皮葡糖球菌和屎肠球菌；真菌31株（5.2%），以热带念珠菌为主。主要肠杆菌科细菌对碳青霉烯类、哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和替加环素的耐药率分别为11.0%、15.3%、15.4%和3.3%。主要非发酵菌对哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和喹诺酮类抗菌药物耐药率分别为29.6%、13.3%和21.7%。81株革兰阳性菌中仅2例对糖肽类抗菌药物耐药。 结论： 2018-2021年南方医科大学南方医院血液科恶性血液病患者血流感染以革兰阴性菌为主，不同菌种耐药率差异较大。.
Objective: To examine the efficacy and safety of third-party bone marrow-derived mesenchymal stem cells (MSCs) in the treatment of refractory delayed hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Twenty patients with refractory LOHC received conventional therapy combined with MSCs obtained from third-party donors' bone marrow (BM) . MSCs were given intravenously at a dose of 1 × 10(6) cells/kg once weekly until either the symptoms improved or no changes in LOHC were seen after continuous infusion four times. BK viruria (BKV) -DNA, JC viruria (JCV) -DNA, and CMV-DNA were detected by real-time quantitative PCR before and 8 weeks after the MSCs infusion. Results: ① Of the 20 patients with refractory LOHC, 15 were males, and 5 were females, and the median age was 35 (15-56) years. There were 5 cases of acute lymphoblastic leukemia (ALL) , 9 cases of acute myeloid leukemia (AML) , 5 cases of myelodysplastic syndrome (MDS) , and 1 case of maternal plasma cell like dendritic cell tumor (BPDCN) . There were 4 cases of HLA identical transplantation and 16 cases of HLA incomplete transplantation. ②The median number of MSC infusions for each patient was 3 (range: 2-8) . Seventeen patients achieved complete response, and one had a partial response after treatment. The overall response rate was 90%. Over a median follow-up period of 397.5 days (range 39-937 days) post-transplantations, 13 patients survived, and 7 died. The causes of death included aGVHD (1 case) , infections (5 cases) , and TMA (1 case) . ③The copy numbers of BKV-DNA and CMV-DNA in urine in the 8th week after MSCs infusion were significantly lower than those observed before treatment (11342.1×10(8) copies/L vs 5.2×10(8) copies/L, P=0.016; 3170.0×10(4) copies/L vs 0.2×10(4) copies/L, P=0.006, respectively) , while JCV-DNA did not significantly differ when compared to before treatment (P=0.106) . ④ No adverse reactions related to MSC infusion occurred in any of the 20 patients. Conclusion: Third-party bone marrow-derived MSC has significant efficacy and good safety in the treatment of refractory LOHC after allogeneic HSCT.目的： 观察第三方骨髓来源间充质干细胞（MSC）治疗异基因造血干细胞移植（allo-HSCT）后难治性迟发性出血性膀胱炎（LOHC）的疗效和安全性。 方法： 回顾性分析2018年7月至2020年6月allo-HSCT后发生难治性LOHC 20例患者在常规治疗基础上联合第三方骨髓来源MSC治疗。MSC以每次1×10(6)/kg、每周1次输注，直至症状改善或连用4次无效停用。在MSC治疗前及治疗后第8周应用定量PCR法检测患者尿液标本中BK病毒（BKV）、JC病毒（JCV）、巨细胞病毒（CMV）。 结果： ①20例难治性LOHC患者中，男15例、女5例，中位年龄35（15～56）岁；急性淋巴细胞白血病（ALL）5例，急性髓系白血病（AML）9例，骨髓增生异常综合征（MDS）5例，母细胞性浆细胞样树突细胞瘤（BPDCN）1例；HLA全相合移植4例，HLA不全相合移植16例。②MSC输注中位次数为3（2～8）次。17例患者获得完全缓解，1例获得部分缓解，总缓解率为90.0%。移植后中位随访397.5（39～937）d，13例存活、7例死亡，死亡原因包括急性GVHD 1例、感染5例、血栓性微血管病（TMA）1例。③MSC输注后第8周尿BKV-DNA及CMV-DNA拷贝数较治疗前显著降低（11342.1×10(8)拷贝/L对5.2×10(8)拷贝/L，P＝0.016；3170.0×10(4)拷贝/L对0.2×10(4)拷贝/L，P＝0.006），而JCV-DNA与治疗前相比无明显改变（P＝0.106）。④未发生MSC输注相关不良反应。 结论： 第三方骨髓来源MSC对allo-HSCT后难治性LOHC具有显著疗效且安全性良好。.
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