血液科医院感染病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens causing nosocomial infections in hematology department

作　　者：刘妍丽[1,2] 杨时佳 简翠[3] 孙自庸[3] 李登举[2] 

机构地区：[1]武汉市结核病防治所,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院血液科,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院检验科,湖北武汉430030

出　　处：《中华医院感染学杂志》2014年第4期825-827,共3页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(2013CFB075)

摘　　要：目的分析医院血液科患者医院感染的病原菌分布及耐药性,为临床合理选择抗菌药物提供依据。方法回顾性分析2011年1月-2012年12月分离自血液科感染患者送检标本的检出病原菌,菌株鉴定使用法国生物梅里埃公司VITEK-2Compact全自动鉴定仪鉴定,采用K-B法进行药物敏感试验,所得数据采用SPSS12.0软件进行统计分析。结果血液科病区177例感染患者标本中共分离出病原菌248株,其中革兰阴性杆菌136株占54.8%,革兰阳性球菌86株占34.7%,真菌26株占10.5%;感染部位包括血液38.3%、痰液25.8%、尿液14.9%、伤口分泌物11.3%和骨髓3.2%等;标本采集时接受中心静脉置管占34.5%;粒细胞缺乏占29.4%;行造血干细胞移植占9.6%;鲍氏不动杆菌和肠球菌属对抗菌药物的耐药率最为严重,耐药率较低的主要包括万古霉素、替考拉宁、亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和头孢吡肟,未检出耐利奈唑胺革兰阳性菌。结论血液科病区患者医院感染易感因素多,部分菌株具有高耐药性,分析医院感染病原菌分布和耐药性,有利于指导临床医师经验性选择和规范使用抗菌药物。OBJECTIVE To analyze the distribution and drug resistance of pathogens causing nosocomial infections in the patients of hematology department wards so as to provide basis for reasonable clinical use of antibiotics. METHODS From Jan 2011 to Dec 2012, the pathogens isolated from the submitted specimens from the patients of hematology department wards were retrospectively analyzed, then the identification of strains was performed with the use of VITEK-2 Compact system of BioM6rieux, France, the drug susceptibility testing was conducted by using K-B method, and the statistical analysis of the obtained data was performed with the use of SPSS12. 0 software. RESULTS A total of 248 strains of pathogens have been isolated from the specimens obtained from 177 cases of infections in the hematology department wards, including 136 （54.8%） strains of gram-negative bacilli, 86 （34.7%） strains of gram-positive cocci, and 26 （10.5%） strains of fungi; 38.3% of the strains were isolated from the blood, 25.8% from sputum, 14. 9% from urine, 11. 3% from wound secretions, 3. 2% from bone marrow. When the specimens were collected, the patients receiving central venous catheterization accounted for 34.5 %, the patients with agranulocytosis 29.4%, the patients undergoing hematopoietic stem cell transplantation 9.6%. The drug resistance rates of the Acinetobacter baumannii and Enterococci were the highest, and the drug resistance rates to vancomycin, teieoplanin, imipenem, meropenem, piperacillin/tazobactam, eefoperazone/ sulbactam, and cefepime were low the gram-positive bacteria that were resistant to linezolid have not been detected. CONCLUSION There are many predisposing factors for nosocomial infections in the patients of hematology department wards; some of the strains are highly drug resistant; the analysis of the distribution and drug resistance of the pathogens causing nosocomial infections may facilitate the empirical medication as wellas the reasonable use of antibiotics.

关 键 词：血液科 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]