恶性血液病患者血流感染病原菌分布与耐药性分析  

Distribution and drug resistance analysis of pathogens isolated from patients with hematologic malignancies

作　　者：曾利军[1] 尹秀云[1] 于农[1] 陈水平[1] 陈建魁[1] 蒋虔[1] 王琳[1] 李一鹤[1] 杨哲[1] 

机构地区：[1]军事医学科学院附属医院检验科,北京100071

出　　处：《中华医院感染学杂志》2015年第11期2434-2436,共3页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2013ZX10004203);国家重大科学仪器设备开发专项基金资助项目(2012YQ18011708)

摘　　要：目的了解恶性血液病患者血流感染的病原菌分布特点及耐药性,为临床合理选用抗菌药物、有效控制感染提供依据。方法收集2012年1月-2013年10月医院恶性血液病患者送检的血培养标本3 609份,采用Bact/ALERT 3D全自动血培养仪及其配套的血培养瓶、VITEK-2全自动微生物鉴定及药敏分析仪,对分离出的病原菌及药敏结果进行回顾、整理、分析。结果恶性血液病患者送检的3 609份血培养标本中254份阳性,阳性率为7.0%;共分离出病原菌261株,革兰阴性菌173株占66.3%,前3位为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌,革兰阳性菌71株占27.2%,前3位为表皮葡萄球菌、屎肠球菌、金黄色葡萄球菌,真菌7株占2.7%,以热带假丝酵母菌为主;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星的耐药率较低,均<20.0%,铜绿假单胞菌对美罗培南、阿米卡星、哌拉西林/他唑巴坦、头孢吡肟、左氧氟沙星等的耐药率均<10.0%;葡萄球菌属及屎肠球菌对喹奴普汀/达福普汀、利奈唑胺的耐药率均为0。结论恶性血液病患者血液中分离病原菌种类繁多,耐药性严重,及时有效进行病原菌及耐药性监测十分必要。OBJECTIVE To investigate the bloodstream infection pathogens in patients with hematologic malignancies and drug distribution characteristics so as to provide the basis for reasonable application of antibiotics and effective infection control .METHODS A total of 3609 patients with hematologic malignancies admitted in the hospital from Jan .2012 to Oct .2013 were selected .Bact /ALERT 3D full‐automatic blood culture machine ,the matched culture bottle and VITEK‐2 antomaric microbiological system and drug sensitivity analyzer were adopted to review ,clear up and analyze the isolated pathogens and drug sensitive results .RESULTS Totally 254 samples proved to be positive in the 3609 blood culture samples and the positive rate was 7 .0% .A total of 261 strains of pathogens were isolated ,including 173 strains of gram‐negative bacteria ,accounting for 66 .3% .The top three wereEscherichiacoli,Pseudomonasaeruginos,andKlebsiellapneumoniae ;and71strainsofgram‐positivebacte‐ria ,accounting for 27 .2% .The top three were S .epidermidis ,Enterococcus faecali ,and Staphylococcus aureus ;fungal hold 7 strains （2 .7% ） ,mainly in Candida tropicalis .The drug susceptibility rate of E .coli and K .pneu‐moniae to imipenem ,meropenem ,and amikacin were relatively low and the rate was less than 20 .0% .The drug susceptibility rate of Pseudomonas aeruginosa to meropenem ,amikacin ,piperacillin/tazobactam ,cefepime and levofloxacin were less than 10 .0% ;Staphylococcus and E .f aecium were totally not resistant to quinupristin/dal‐fopristin and linezolid .CONCLUSION Blood pathogens isolated from patients with hematologic malignancies were widely distributed and highly drug resistant ,it is very necessary to monitor the pathogens and drug resistance timely and effectively .

关 键 词：恶性血液病 血流感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]