肿瘤患者医院感染革兰阳性球菌的分布与耐药性分析  

Distribution and drug resistance of gram-positive cocci causing nosocomial infections in tumor patients

作　　者：叶彩玲[1,2] 江奕楠 潘扬勋 陈崇翔 赵擎宇[1] 

机构地区：[1]中山大学肿瘤防治中心医院感染管理科,广东广州510060 [2]中山医学院临床医学系,广东广州510060

出　　处：《中华医院感染学杂志》2016年第11期2522-2525,共4页Chinese Journal of Nosocomiology

基　　金：国家卫生计生委专项基金资助项目(1311200006402)

摘　　要：目的调查肿瘤患者医院感染革兰阳性球菌的分布及其对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法回顾性调查中山大学肿瘤防治中心2014年172例革兰阳性球菌感染患者临床资料,所有标本均采用法国生物梅里埃公司VITEK-32微生物鉴定系统进行菌种鉴定和耐药性分析,并采用EXCEL8.0和WHONET5.4软件对感染者的基本情况、科室分布、标本分布和耐药性进行分析。结果医院感染患者中共分离出172株革兰阳性球菌,主要来源于咽拭子、痰及引流液;革兰阳性球菌分离率较高的科室为放疗科、ICU及胸科;革兰阳性球菌以链球菌属和葡萄球菌属为主,分别占43.6%和40.1%;链球菌属对红霉素及磺胺甲噁唑/甲氧苄啶耐药率>85.0%,对利奈唑胺和万古霉素敏感率为100.0%;肠球菌属对克林霉素及红霉素耐药严重,对替考拉宁和替加环素敏感率为100.0%,此外发现1株耐万古霉素肠球菌(VRE);葡萄球菌属对青霉素、苯唑西林的耐药性>85.0%,而对利奈唑胺和替加环素敏感率为100.0%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为60.0%和89.8%。结论医院感染革兰阳性球菌标本主要来源于呼吸道,以链球菌属和葡萄球菌属为主;其耐药性较严重,多药耐药明显,出现了VRE,临床应提高警惕。OBJECTIVE To investigate the distribution of gram-positive cocci causing nosocomial infections in tumor patients and analyze the drug resistance to the commonly used antibiotics so as to provide guidance for reasonable clinical use of antibiotics.METHODS The clinical data of 172 patients with gram-positive cocci infections who were treated in the Cancer Center of Sun Yat-sen University in 2014 were retrospectively investigated,the bacterial identification was carried out for all the specimens by using VITEK-32 micro organism identification system of bioMérieux,France,and the drug resistance was analyzed.The basic information of the patients with infections,distribution of departments,distribution of specimens,and drug resistance were observed by using EXCEL8.0software and WHONET5.4software.RESULTS A total of 172 strains of gram-positive cocci were isolated from the patients with nosocomial infections,most of which were isolated from throat swab,sputum,and drainage fluid specimens.The isolation rate of the gram-positive cocci was relatively high in the department of radiotherapy,ICU,and department of thoracic surgery.The Streptococcus sppand Staphylococcus spp were dominant among the gram-positive cocci,accounting for 43.6%and 40.1%,respectively.The drug resistance rates of the Streptococcus sppto erythromycin and sulfamethoxazole-trimethoprim were more than 85.0%,and the drug susceptibility rates to linezolid and vancomycin were 100.0%.The Enterococcus spp was highly resistant to clindamycin and erythromycin,the drug susceptibility rates to teicoplanin and tigecycline were 100.0%.In addition,1strain of vancomycin-resistant Enterococcus（VRE）was found.The drug resistance rates of the Staphylococcus spp to penicillin and oxacillin were more than 85.0%,however,the drug susceptibility rates to linezolid and tigecycline were100.0%.The isolation rates of the methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococcus（MRCNS）were 60.0% and 89.8%,respectively.CO

关 键 词：肿瘤 医院感染 革兰阳性球菌 耐药性分析 

分 类 号：R378.11[医药卫生—病原生物学]