血液病患者败血症病原菌分析  

Analysis of pathogenic bacteria distribution of hematologic malignancies patients with septicemia

作　　者：田祖国[1] 李佳[2] 黄乐[1] 

机构地区：[1]遵义医学院附属医院血液内科,贵州遵义563003 [2]遵义医学院附属医院新生儿科,贵州遵义563003

出　　处：《中华医院感染学杂志》2014年第14期3399-3401,共3页Chinese Journal of Nosocomiology

基　　金：贵州省科学技术基金资助项目(黔科合J字LKZ[2012]09)

摘　　要：目的研究血液病患者败血症的病原菌分布及药敏性,为临床治疗提供参考。方法回顾性分析2010年1月-2013年1月69例血液病患者败血症的临床特征、病原菌分布及药物敏感试验结果。结果血液病合并败血症患者72.5%处于粒细胞缺乏期;共培养出72株细菌,革兰阴性菌占63.9%,主要为大肠埃希菌、铜绿假单胞菌及肺炎克雷伯菌,25株大肠埃希菌中产ESBLs菌21株,8株铜绿假单胞菌中产ESBLs菌6株,产ESBLs菌对常见抗菌药物耐药性较高,对亚胺培南和阿米卡星敏感性较好,为96.4%,其他均<50.0%,肺炎克雷伯菌对抗菌药物敏感性较好;革兰阳性菌占36.1%,主要为人葡萄球菌、表皮葡萄球菌及金黄色葡萄球菌,分别占26.9%、19.2%和15.4%,对万古霉素、利福平、呋喃妥因、喹奴普汀/达福普汀的敏感性良好。结论粒细胞缺乏是血液病患者发生败血症的重要因素,败血症病原菌以革兰阴性杆菌为主,产ESBLs菌可优先选择亚胺培南及阿米卡星治疗。OBJECTIVE To investigate the pathogenic bacteria distribution and drug sensibility of hematologic malignancies patients with septicemia,so as to provide reference for clinical treatment.METHODS Clinical features,pathogenic bacteria and drug sensitivity test results of 69patients with hematological malignancies combined septicemia were retrospectively analyzed from Jan.2010to Jan.2013.RESULTS The 72.5%of patients were in the agranulocytosis period.A total of 72strains were detected in the blood samples,gram-negative bacteria accounted for 63.9%,the main bacteria were Eschericlia.coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae.A total of 21strains of ESBLs were in 25strains of E.coli,6strains in 8strains of P.aeruginosa,ESBLs had higher resistance to common antibiotics,but had higher sensibility to imipenem and amikacin,which was 96.4%,but for other lower than 50.0%.K.pneumoniae had highly sensibility to antibiotics.Gram-positive bacteria accounted for 36.1%,the main bacteria were People aureus,Staphylococcus epidermidis and Staphylococcus aureus,accounted for 26.9%,19.2%and 15.4%,respectively.All were sensitive to vancomycin,rifampin,macrodantin and quinupristin.CONCLUSION Agranulocytosis in patients with hematologic malignancies is an important factor in sepsis,the major pathogen of sepsis is gram-negative bacteria,ESBLs-positive bacteria prefer imipenem and amikacin for treatment.

关 键 词：血液病 败血症 粒细胞缺乏 病原菌 药敏试验 

分 类 号：R378[医药卫生—病原生物学]