白血病患者并发院内败血症的病原菌分析  

Pathogen Analysis of Leukaemia Patients with Nosocomial Sepsis

作　　者：陈黎黎[1] 陈永平[1] 戴春蕾[1] 王雅琴[1] 王晓东[1] 

机构地区：[1]温州医学院附属第一医院感染科,325000

出　　处：《医学研究杂志》2013年第1期154-157,共4页Journal of Medical Research

摘　　要：目的了解白血病患者并发院内败血症的致病菌分布及其对抗菌药物的敏感性,为临床治疗提供参考。方法对笔者医院2007年1月1日～2011年12月31日收住入院的白血病患者所并发的院内败血症的致病菌分布及其耐药性进行回顾性分析。结果 55个血液标本中共检出56株致病菌。革兰阴性菌共40株,占71.4%,前3位依次是大肠杆菌(15株)、肺炎克雷伯菌(10株)、铜绿假单胞菌(5株)。革兰阳性菌共12株,占23.2%,以金黄色葡萄球菌为主;真菌3株。56株致病菌中含有7株非发酵菌、12株产ESBLs菌。主要致病菌的耐药性:大肠杆菌和肺炎克雷伯菌对氨苄西林耐药性最高,耐药率>93.3%,对碳青霉烯类全部敏感。铜绿假单胞菌对头孢唑啉、头孢曲松、复方新诺明均耐药,对哌拉西林/他唑巴坦、头孢吡肟、碳青霉烯类、庆大霉素、左氧氟沙星均敏感。金黄色葡萄菌对青霉素G耐药率100%,对糖肽类、左氧氟沙星、利奈唑胺均敏感。结论笔者医院白血病并发院内败血症的致病菌以G-菌为主;主要致病菌对常用抗菌药物耐药现象严重,须加强抗菌药物的合理使用。Objective To analyze the bacterial distribution and drug resistance in leukaemia patients with nosocomial sepsis which can guide the clinicians towards better treatment. Methods A retrospectively study of bacterial distribution and drug resistance of leukaemia patients with nosocomial sepsis in The First Affiliated Hospital of Wenzhou Medical College from January 1 st,2007 to December 31st, 2011 had been made. Results Fiflysix pathogens were detected in 55 patients＇blood sample including 40 （71.4%） Gram - negative bacteria, 13 （23.2%） Gram - positive bacteria and the remaining 3 （ 5.4% ） were fungi. The most common Gram - negative bacteria was Escherichia coli （ 15 strains）, followed by Klebsiella pneumoniae （ 10 strains） and Pseudomonas aeruginosa （ 5 strains）. Most of Gram - positive bacteria were Staphylococcus aureus（ 10.7% ）. Seven were non -fermentative bacteria, 12 were producing extended spectrum beta-lactamase（ESBLs）. Resistance analysis demonstrated that the main pathogens involved were Escheriehia coli and Klebsiella pneumonia： the rate of resistance to ampicillin were more than 93% , but both were sensitive to earbapenems. All of Pseudomonas aeruginosa were resistant to cefazolin, ceftriaxone,cotrimoxazole. Aureus were penicillin - resistant, but sensitive to glycopeptides, quinolones, linezolid. Conclusion The pathogens of leukaemia associated with nosocomial sepsis were G - ,and high rate of drug - resistance was demonstrated in our study. Thus, it is imperative to enhance the reasonable use of antibiotics.

关 键 词：白血病 医院感染 败血症 致病菌 耐药性 

分 类 号：R733.7[医药卫生—肿瘤]