2014至2015年江苏省血液科病房病原菌分布及耐药状况的多中心回顾性研究  

Distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015： results from a multieenter, retrospective study

作　　者：万一柯 桑威 陈兵[1] 杨永公[1] 张鲁勤[3] 孙爱宁[4] 刘跃均[4] 徐杨[4] 蔡益鹏 王纯斌[6] 沈云峰[7] 姜扬文[8] 张晓艳[9] 徐卫[9] 洪鸣[9] 陈涛[10] 徐瑞容[11] 李锋[12] 徐燕丽[13] 薛燕[14] 陆益龙[15] 何正梅[16] 董伟民[17] 陈泽[18] 季美华[19] 杨月艳[20] 翟丽佳[21] 赵钰[22] 吴光启[23] 丁家华[24] 程坚[24] 蔡伟波[25] 孙雨梅[26] 欧阳建[1] 

机构地区：[1]南京大学医学院附属南京鼓楼医院,210008 [2]徐州医科大学附属医院 [3]徐州市第一人民医院 [4]苏州大学附属第一医院 [5]盐城市第一人民医院 [6]盐城市第三人民医院 [7]无锡市人民医院 [8]苏北人民医院 [9]江苏省人民医院 [10]常州市第二人民医院 [11]南通大学附属医院 [12]南京总医院 [13]南京市第一医院 [14]徐州市中心医院 [15]江苏大学附属医院 [16]淮安市第一人民医院 [17]常州市第一人民医院 [18]连云港市第一人民医院 [19]南通市第一人民医院 [20]江苏省中医院 [21]扬州市第一人民医院 [22]江苏省江阴市人民医院 [23]宿迁市人民医院 [24]东南大学附属中大医院 [25]苏州市立医院 [26]淮安市第二人民医院

出　　处：《中华血液学杂志》2017年第7期602-606,共5页Chinese Journal of Hematology

摘　　要：【摘要】目的回顾性分析2014至2015年江苏省血液科常见病原菌的分布及对常用抗生素的耐药状况，为临床经验性抗感染治疗提供参考。方法2014年1月至2015年12月江苏省26所三级医院血液科病房分离病原菌采用琼脂稀释法或纸片法进行药敏试验，收集药敏结果和对应患者临床资料进行分析。结果共分离出病原菌4306株，革兰阴性菌（G-菌）占64．26％，革兰阳性菌（G’菌）占26．99％，真菌占8．75％。常见G-菌为大肠埃希菌（20．48％）、肺炎克雷伯菌（15．40％）、铜绿假单胞菌（8．50％）、鲍曼不动杆菌（5．04％）及嗜麦芽窄食单胞菌（3．41％），其中耐碳青霉烯类抗生素的肠杆菌（CRE）123株，占肠杆菌科分离菌的6．68％。常见G’菌为金黄色葡萄球菌（4．92％）、人葡萄球菌（4．88％）、表皮葡萄球菌（4．71％）。白色念珠菌占所有病原菌的5．43％，占真菌的62．07％。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗生素的耐药率为3．5％～6．1％、5．0％～6．3％；铜绿假单胞菌对妥布霉素、丁胺卡那霉素的耐药率为3．2％、3．3％；鲍曼不动杆菌对妥布霉素、头孢哌N／舒巴坦的耐药率均为19．2％；嗜麦芽窄食单胞菌对米诺环素、复方磺胺甲恶唑的耐药率为3．5％、9．3％。金黄色葡萄球菌、屎肠球菌、粪肠球菌对万古霉素的耐药率分别为0、6．4％、1．4％，对利奈唑胺的耐药率分别为1．2％、0、1．6％，对替考拉宁的耐药率分别为2．8％、14．3％、8．O％。耐甲氧西林金黄色葡萄球菌（MRSA）83株，占金黄色葡萄球菌的39．15％。结论分离病原菌以G-菌为主，CRE已达肠杆菌科分离菌的6．68％，大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗生素的耐药率均较低，常见G-菌对万古霉素、利奈唑胺及替考拉宁的耐药率低，MRSA占金黄色葡萄球菌的39．15％。Objective To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results The separated pathogens amounted to 4 306. Gram- negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli（20.48%）, Klebsiella pneumonia （15.40%）, Pseudomonas aeruginosa （8.50%）, Acinetobacter baumannii（5.04%） and Stenotropho- monas maltophilia （3.41%） respectively. CRE amounted to 123 （6.68%）. Common gram-positive bacteria were Staphylococcus aureus （4.92%）, Staphylococcus hominis （4.88%） and Staphylococcus epidermidis （4.71%） respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/ sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% （8

关 键 词：血液病 细菌感染和真菌病 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]