恶性血液病患者感染病原菌分布及耐药性分析  

Analysis of the distribution and drug resistance of pathogenic bacteria in patients with malignant hematologic disease

作　　者：周文静[1] 马筱玲[2] 高朋[1] 常文娇[2] 周馨[2] 张翠萍[2] 

机构地区：[1]蚌埠医学院,安徽蚌埠233003 [2]安徽医科大学附属省立医院检验科

出　　处：《中国感染与化疗杂志》2011年第4期291-294,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解恶性血液病患者发生细菌感染的特点及病原菌的耐药性特征,为临床合理用药提供依据。方法对安徽医科大学附属省立医院111例恶性血液病患者中分离的病原菌的分布进行回顾性分析,结合临床抗菌药物使用情况分析其对抗菌药物耐药性特征。结果最常见细菌感染部位为血流感染(69例,62.2%),其次为呼吸道感染(22例,19.8%)。病原细菌中革兰阴性杆菌占75%,其余为革兰阳性球菌;同时检出7株真菌。各类病原菌的耐药性严重,大肠埃希菌和肺炎克雷伯菌中ESBLs的检出率分别为82.9%和54.5%;葡萄球菌中分别检出MRSA 2株和MRCNS 12株。革兰阴性菌对亚胺培南、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、阿米卡星仍有较好敏感性,葡萄球菌对万古霉素、利奈唑胺、奎奴普丁-达福普汀仍较敏感。鉴于ESBLs的高检出率,头孢菌素类抗生素可能已不适宜作为经验用药。结论恶性血液病患者中分离的菌株多重耐药情况严重。应参考本地区感染细菌分布和耐药特点合理选择抗菌药物。Objective To explore the characteristics of infection in patients with malignant hematologic disease and the drug resistance of pathogenic bacteria.Methods The distribution of pathogens and the associated use of antimicrobial agents were analyzed retrospectively in 111 patients with malignant hematologic disease.Results The most common infection was blood stream infections（69,62.2%）,followed by respiratory infections（22,19.8%）.Gram-negative bacilli accounted for 75%.Seven strains of fungus were also isolated.Antibiotic resistance was a serious issue in all the bacterial species.The prevalence of ESBLs in E.coli and Klebsiella spp.were 82.9% and 54.5%,respectively.Two strains of S.aureus and 12 strains of coagulase-negative Staphylococcus were resistant to penicillin.Gram-negative bacilli were relatively susceptible to imipenem,cefoperazone-sulbactam,piperacillin-tazobactam and amikacin.Staphylococcus isolates were susceptible to vancomycin,linezolid and quinupristin-dalfopristin.Cephalosporins may not be the first choice in empirical therapy due to the high prevalence of ESBLs.Conclusions The pathogens isolated from patients with hematologic malignancies are highly resistant to multiple antibiotics.Antimicrobial therapy should be decided cautiously in accordance with local pathogen distribution and its resistant pattern.

关 键 词：恶性血液病 细菌感染 抗菌药物 耐药性 

分 类 号：R446.5[医药卫生—诊断学]