急性白血病患者败血症病原菌及耐药性分析  

Analysis of pathogenic bacteria and drug resistance in acute leukemia patients with septicemia

作　　者：宁方颖[1] 蓝建平[1] 钱美华[1] 杨天新[1] 金莱[1] 解鸿翔[2] 

机构地区：[1]浙江省人民医院血液内科,浙江杭州310014 [2]浙江省人民医院检验科,浙江杭州310014

出　　处：《中国卫生检验杂志》2017年第11期1642-1645,1648,共5页Chinese Journal of Health Laboratory Technology

基　　金：浙江省医药卫生科技计划项目(2016KYA010)

摘　　要：目的了解本院急性白血病(AL)患者败血症的病原菌及耐药性,为临床合理使用抗生素提供依据。方法回顾性分析2012年-2016年本院血液科104例AL患者发生败血症的病原菌分布和耐药性。结果 AL发生败血症75%处于粒细胞缺乏期,共分离出病原菌108株,以革兰阴性菌为主(51.9%),其中以大肠埃希菌最为常见(24.1%),革兰阳性菌有明显上升趋势(46.3%),真菌占1.8%。主要革兰阴性杆菌对阿米卡星、头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦、妥布霉素的总体耐药率较低,对头孢类抗生素呈现较高的耐药率。大肠埃希菌及肺炎克雷伯菌肺炎亚种产超广谱β内酰胺酶(ESBLs)的比例分别为65.4%、40.0%,其对常见抗菌药物的耐药率较高。未发现耐万古霉素和利奈唑胺的葡萄球菌株。结论 AL败血症病原菌仍以革兰阴性菌为主,但革兰阳性菌有所上升,密切关注其病原学特点,可以进行有效经验性抗感染及控制耐药率。Objective To investigate the pathogens and drug resistance of septicemia in patients with acute leukemia （AL） in our hospital, so as to guide rational use of antibiotics. Methods The distribution and drug resistance of pathogens in 104 AL patients with septicemia were analyzed retrospectively in our hospital from 2012 to 2016. Results 75% of patients were in the agranulocytosis period. 108 strains of pathogenic bacteria were isolated, which mainly were gram - negative bacteria（51.9% ） , of which Escherichia coli was the most common（24.1% ）, gram- positive organiams increased significantly （46.3%）, and Fungi accounted for 1.8%. The overall resistance rate of the main gram - negativebacteria to amikacin, cefoperazone/sulbac- tam, imipenem, piperacillin/tazobactam and tobramycin was less. However, the cephalosporin antibiotics showed a high resist- ance rate to them. The detection rates of extended - spectrum [3 - lactamases （ESBLs） producing Escherichia coli and Klebsiella pneumoniae were respectively 65.4% and 40.0% , which were highly resistant to common drugs. Staphylococcus aureus strains that were resistant to vancomycin and linezolid were not detected. Conclusion The bacteria of septicemia in AL is mainly gram -negative, but gram- positive pathogens increased. Paying close attention to its etiological characteristics is important to rationally select antibiotics and control the drug resistance rate.

关 键 词：急性白血病 败血症 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]