恶性肿瘤患者医院感染病原菌分类及耐药性  

Species of pathogenic bacteria causing nosocomial infections in patients with malignant tumors and drug resistance

作　　者：王顺[1] 王永涛[1] 贾征夫[1] 

机构地区：[1]武汉市第一医院检验科,湖北武汉430022

出　　处：《中华医院感染学杂志》2013年第22期5559-5561,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解恶性肿瘤患者继发医院感染的病原菌种类及对抗菌药物药物的耐药特点,为医治感染性疾病提供选药指南。方法调查医院329例恶性肿瘤继发医院感染患者的临床资料;感染性标本收集运送、分离培养、菌株鉴定均严格按照临床微生物学检验的常规程序进行操作;药敏试验按照WHO指定的纸片扩散法(K-B法),抑菌圈直径测量及敏感、中介、耐药数据的读取参照CLSI 2009-2012年新折点分析;药敏数据处理采用WHONET 5.5软件进行;试验过程实施全程质量控制。结果 329例肿瘤患者发生医院感染345例次,部分患者同时发生多部位感染,感染部位以下呼吸道感染最多见,占67.0%,其次为泌尿道和皮肤软组织,分别占13.9%和9.9%;从329例恶性肿瘤患者感染标本中培养得到389株病原菌,其中革兰阴性杆菌257株占66.1%,革兰阳性球菌86株占22.1%,真菌46株占11.8%,排名前5位病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌、大肠埃希菌,分别占20.8%、16.2%、11.1%、8.5%、7.7%;肺炎克雷伯菌对亚胺培南、美罗培南100.0%敏感;泛耐药铜绿假单胞菌和鲍氏不动杆菌检出率分别达到12.3%、14.0%;产ESBLs细菌检出44株,检出率47.3%;耐甲氧西林葡萄球菌检出29株,检出率51.8%。结论恶性肿瘤患者医院感染致病菌的品种繁多、多药耐药和交叉耐药现象严重,因此,医院务必要执行《抗菌药物临床应用管理办法》,提高医师抗感染的处方水平,控制细菌耐药性不断上升的危险现状。OBJECTIVE To understand the species of pathogenic bacteria causing secondary nosocomial infections in the patients with malignant tumors and analyze the characteristics of drug resistance so as to provide guidance for treatment of infectious diseases. METHODS The clinical data of 329 cases of malignant tumors patients complicated with secondary nosocomial infections were investigated, then the collection and shipping of specimens, isolation and culture, and strain identification were performed in strict accordance with the routine procedures of the clinical microorganism laboratory; the drug susceptibility testing was carried out by using the disc diffusion method（K-B method） specified by WHO; the data of the measurement of diameter of inhibition zone, drugs susceptibility, drug intermediary, and drug resistance were interpreted by referring to the CLSI 2009- 2012; the data of drug susceptibility testing were statistically analyzed with the use of WHONET 5.5 software, and the whole-process quality control was conducted throughout the testing. RESULTS Of totally 329 cases of malignant tumors patients investigated, the nosocomial infections occurred in 345 case-times, some of which were complicated with multiple sites infections. The lower respiratory tract was the most common infection site, accounting for 67.0%, followed by the urinary tract（13.9%） and the skin and soft tissue （9.9%）. Totally 389 strains of pathogens were isolated from the infectious specimens obtained from the 329 malignant tumors patients, including 257 （66.1%） strains of gram-negative bacilli, 86 （22.1%） strains of gram-positive cocci, and 46 （11. 8%） strains of fungi; the Pseudomonas aeruginosa , Klebsiella pneumoniae , Acinetobacter baurnanii , Staphylococcus aureus and Escherichia coli ranked the top 5 species of pathogens, accounting for 20.8%, 16.2%, 11.1%, 8.5%, and 7.7%, respectively. The K. pneurnoniae strains were 100.0% susceptible to imipenem and meropenem; the detection rate of pandrug -resistant P. aerugino

关 键 词：肿瘤患者 医院感染 细菌 抗菌药物 耐药特性 

分 类 号：R378[医药卫生—病原生物学]