医院血液病细菌感染患者的病原菌分布和临床特点分析  

Pathogenic bacteria distribution and clinical characteristics of hematological bacterial infection in a hospital

作　　者：杨晓煜[1] 陈精予[1] 宋春鸽[1] 庞素蕾[1] YANG Xiao-yu CHEN Jing-yu SONG Chun-ge PANG Su-lei(The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, Chin)

机构地区：[1]郑州大学第五附属医院血液内科,河南郑州450052

出　　处：《中华医院感染学杂志》2017年第4期746-749,共4页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅医药科技计划项目(201582zx)

摘　　要：目的探讨医院血液病细菌感染患者的病原菌分布及其耐药性,为细菌感染的临床预防控制提供参考依据。方法选取2012年4月-2016年3月医院收治的血液病细菌感染患者612例,共收集阳性细菌标本648份,统计标本来源、菌株分布及不同菌种对临床常用抗菌药物的耐药性,数据采用SPSS19.0软件进行统计分析。结果 648份阳性标本中以血液标本最多421份,占64.97%,其次为痰液91份,占14.04%,脓性分泌物、导管末端、尿液、胸/腹水标本来源均<10.00%;612例患者中共检出648株病原菌,其中革兰阳性菌213株占32.87%,主要以凝固酶阴性葡萄球菌为主,革兰阴性菌435株占67.13%,主要以大肠埃希菌为主;凝固酶阴性葡萄球菌对青霉素G、红霉素和苯唑西林具有较高耐药性,但对万古霉素敏感,金黄色葡萄球菌对青霉素G的耐药性最高为96.43%,对红霉素、苯唑西林等抗菌药物具有一定耐药性,但对万古霉素无耐药性;链球菌属对红霉素、克林霉素的耐药率分别为96.15%、76.92%,而对青霉素G、苯唑西林、左氧氟沙星、万古霉素均无耐药性;屎肠球菌对青霉素G的耐药率达100.00%,对苯唑西林和红霉素也具有较高耐药性,但对莫西沙星和万古霉素无耐药性;大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌对氨苄西林的耐药率均>80.00%,嗜麦芽寡养单胞菌对呋喃妥因的耐药率高达81.48%,主要革兰阳性菌对阿米卡星的耐药率较低。结论血液病患者发生细菌感染的风险较高,且以血液感染最为常见,病原菌对多种常见抗菌药物均具有较强耐药性,临床上应根据细菌培养结果选择合适的抗菌药物。OBJECTIVE To explore the pathogenic bacteria distribution and their drug resistance of bacterial infections of blood diseases in the Fifth Affiliated Hospital of Zhengzhou University,so as to provide guidance for the prevention and control of bacterial infections.METHODS A total of 612 cases of patients with hematological diseases of bacterial infection from Apr.2012 to Mar.2016 in the Fifth Affiliated Hospital of Zhengzhou University were selected,and totally 648 specimens of positive bacteria were collected.The source of specimens,distribution of the strains and drug resistance of different strains to the commonly used antimicrobials were statistically analyzed.SPSS19.0software were used for statistical analysis.RESULTSIn the 648 positive strains,421 were gained from the blood specimens,accounting for 64.97%,followed by 91 cases of sputum（14.04%）,and purulent secretions,catheter end,urine,and chest/ascites sources were less than 10%.Totally 648 strains of pathogenic bacteria were detected,213（32.87%）strains were gram-positive bacteria,mainly were coagulase-negative Staphylococci,and 435 strains were gram-negative bacteria,mainly were Escherichia coli.Coagulase-negative Staphylococci had a high drug resistance to penicillin G,erythromycin and oxacillin,but was sensitive to vancomycin.Staphylococcus aureus had the highest drug resistant rate to penicillin G,which was 96.43%,and had some resistance to erythromycin and oxacillin,but no resistance to vancomycin.The drug resistant rates of Streptococcus to erythromycin and clindamycin were 96.15% and 76.92%,but were 0to penicillin G,oxacillin,levofloxacin and vancomycin.The resistant rate of Enterococcus faeciumto penicillin G reached to 100.00%,and a higher rate to oxacillin and erythromycin,but not to moxifloxacin and vancomycin.The resistant rates of E.coli,Klebsiella pneumoniae and Pseudomonas aeruginosa to ampicillin were all above 80.00%,the resistant rate of Stenotrophomonas maltophiliato nitrofurantoin reached 81.48%,and main gram-positive bacteria ha

关 键 词：血液病 细菌感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]