血液病医院感染病原菌特点及利奈唑胺在粒细胞缺乏感染治疗中的应用  

Pathoges of Infection in Hematologic Patients and Linezolid in Treatment of Gram-positive Bacteria Infection in Patients with Agranulocytosis:Epidemiologic Studies

作　　者：王秀丽[1] 吴德沛[1] 孙爱宁[1] 仇惠英[1] 金正明[1] 苗瞄[1] 唐晓文[1] 何广胜[1] 傅铮铮[1] 韩悦[1] 

机构地区：[1]苏州大学附属第一医院血液科江苏省血液研究所卫生部血栓与止血重点实验室,江苏苏州215006

出　　处：《中华医院感染学杂志》2010年第11期1589-1591,共3页Chinese Journal of Nosocomiology

基　　金：江苏省医学领军人才基金资助(LJ200626);卫生部专项基金资助(200802027)

摘　　要：目的探讨血液病患者医院感染病原菌特点及利奈唑胺在可疑革兰阳性球菌感染的粒细胞缺乏患者疗效。方法统计2005-2008年苏州大学附属第一医院血液科医院感染患者资料,分析100例可疑革兰阳性球菌感染的粒细胞缺乏患者临床特点及利奈唑胺抗感染的临床疗效。结果 4年医院感染发病率平均为36.5%;以呼吸道感染为主,病原菌仍以革兰阴性杆菌为主,大肠埃希菌为第1位致病菌(22.2%),其次为表皮葡萄球菌(16.2%);金黄色葡萄球菌、表皮葡萄球菌及凝固酶阴性葡萄球菌的耐药菌株比例分别为61.3%、81.3%及83.5%,检出2例耐万古霉素肠球菌(VRE);100例患者应用利奈唑胺,98例可评估患者的总有效率为90.8%,其中检出革兰阳性球菌者痊愈率(92.6%)明显高于革兰阴性杆菌者(35.3%)(χ2=11.6,P=0.001)及病原学检查阴性者(55.8%)(χ2=10.3,P=0.001);感染初始即应用利奈唑胺者(45例)比后来换用者(40例)体温控制所需中位时间更短,分别为3.4d及6.6d。结论医院血液病患者医院感染致病菌仍以革兰阴性杆菌为主,以大肠埃希菌最多;革兰阳性球菌耐药比例高达60%～80%;对革兰阳性球菌感染的粒细胞缺乏血液病患者,尽早应用利奈唑胺可取得非常好的抗感染效果。OBJECTIVE To investigate the epidemiological characteristics of the pathogens of the infection in hematological patients and to evaluate the effect of linezolid in the treatment of Gram-positive bacterial infection in the patients with agrannlocytosis. METHODS The data about the patients who suffered from hospital infections in the department of hematology in the First Affiliated Hospital of Soochow University between 2005 and 2008 were analyzed. The clinical characteristics of 100 agrannlocytosis patients infected due to suspected or known Grampositive pathogens were studied to evaluate the efficacy of linezolid in the treatment of them. RESULTS The morbidity of hospital infection during the 4 years was about 36.5 %. Respiratory infection accounted for 55.8% and septicaemia for 11.3%. G^- pathogens as the predominant microbes of the infection accounted for 60. 9 %, while G^＋ pathogens for 26.5 %. The primary one was Escherichia coli （22.2 %） folloued by Staphylococcus epidermidis （16.2 %）. Drug resistant strains such as MRSA, MRSE and MRCNS accounted for 61.3 %, 81. 3 % and 83.5%, respectively. Total effective rate of the 98 patients iniected with linezolid was 90.8% ,and the cure rate of the G^＋ infection was 92.6 %, which was much higher than the G^- infection （35.3 % ）（χ^2= 11.6, P = 0. 001）and those who had no pathogen detected（55. 8%） （χ^2=10. 3, P = 0. 001）. The body temperature recovered more quickly in the fever patients injected linezolid at the beginning of infection （3.4d） than those injected later（6.6 d）. CONCLUSIONS Gram-negative bacteria are the major pathogens, especially E. coli. The ratio of G^＋ drug resistant strain reached to 60-80%. Early using of linezolid will benefit the G^＋ infection patients.

关 键 词：血液病 感染 革兰阳性球菌 革兰阴性杆菌 利奈唑胺 疗效 

分 类 号：R978.1[医药卫生—药品]