血液恶性肿瘤化疗后血流感染的病原菌分布及耐药情况分析  

Distribution and drug resistance of pathogens of blood stream infection in patients with hematological malignancies after chemotherapy

作　　者：陈少桢 林康昵 肖敏 骆晓峰[1] 李芊 任金华[1] 黄若瑶 陈敏敏 Issa Hajji Ally 陈志哲[1] 杨婷[1] 胡建达[1] 

机构地区：[1]福建医科大学附属协和医院血液科,福建省血液病学重点实验室,福建省血液病研究所,福州350001

出　　处：《中华血液学杂志》2017年第11期951-955,共5页Chinese Journal of Hematology

基　　金：基金项目：福建省血液医学中心建设项目[闽政办（2017）4号];国家临床重点专科建设项目[闽财指（2011）1006号];福建省临床重点专科建设项目[闽卫科教（2012）149号];国家自然科学基金（81570162、81700131）;福建省卫计委中青年骨干人才培养项目（2014-ZQN-ZD-8）

摘　　要：目的分析福建医科大学附属协和医院血液科血培养的病原菌分布及药敏情况，以了解临床真实世界血流感染状况，为临床合理使用抗菌药物提供依据。方法收集2013年1月至2016年12月福建医科大学附属协和医院血液科临床送检血培养阳性标本分离出的657株病原菌资料并对患者临床资料进行分析。结果657株血培养阳性菌株中，革兰阴性菌（G-菌）410株（62．4％），革兰阳性菌（G＋菌）163株（24．8％），真菌50株（7．6％）。前五位的致病细菌分别为肺炎克雷伯菌（17．5％）、大肠埃希菌（17．2％）、凝固酶阴性葡萄球菌（cys）（14．9％），铜绿假单胞菌（14．2％）及金黄色葡萄球菌（3．5％）。G菌中肺炎克雷伯菌和大肠埃希菌产超广谱D内酰胺酶（ESBL）菌株的检出率分别为25．2％和55．8％，产ESBL菌株对抗菌药物的耐药率大多高于非产ESBL菌株。肠杆菌科细菌对碳青霉烯类抗生素、哌拉西林／他唑巴坦、替加环素的耐药率均在14％以下。非发酵菌中，铜绿假单胞菌对各种抗菌药物的耐药率均在12．0％以下；鲍曼不动杆菌对头孢克肟和头孢噻肟耐药率均为7．1％，未发现对替加环素耐药的鲍曼不动杆菌。CNS中84．7％（83／98）为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）。金黄色葡萄球菌中43．5％（10／23）为耐甲氧西林金黄色葡萄球菌（MRSA）。未发现对万古霉素、利奈唑胺、替加环素耐药的G’菌。结论福建医科大学附属协和医院血液恶性肿瘤患者化疗后合并血流感染病原菌种类分布较广，以G-菌为主，耐药情况较严峻。临床上对怀疑有G’菌血液感染的患者可经验性选择万古霉素、利奈唑胺或替加环素抗感染治疗。Objective To investigate the distribution and resistance of pathogens isolated from blood cultures in patients with hematological malignancies after chemotherapy in Union Hospital of Fujian Medical University so as to understand the real situation of blood stream infection （BSI） and provide the basis for rational use of antibiotics in clinic. Methods The data of 657 strains isolated from blood culture specimens of patients with hematological malignancies from January 2013 to December 2016 were collected analyzed. Results A total of 657 cases of blood culture positive bacterial strains were included in the study, involving 410 cases （62.4%） with single Gram-negative bacteria （G- bacteria）, 163 cases （24.8%） with single Gram- positive bacteria （G ~ bacteria）, 50 cases （7.6%） with single fungi. The most common 5 isolates in blood culture were Klebsiella pneumoniae （17.5%）, Escherichia coli （17.2%）,Coagulase negative staphylococci （CNS） （ 14.9% ）, Pseudomonas aeruginosa （ 14.2% ） and Staphylococcus aureus （3.5 % ）. The extended- spectrum beta- lactamase （E SBL） production rates of Klebsiella pneumoniae and Escherichia coli were 25.2% and 55.8%, respectively. ESBL producing strains were almost more resistant than non-ESBL producing strains. The resistance rates of Enterobacteriaceae to carbapenems, piperacillin/tazobactam and tigecycline were lower than 14.0%. The resistance rates of Pseudomonas aeruginosa to a variety of drugs were lower than 12.0%. Tigecycline-resistant Acinetobaeter baumannii bacteria were not detected, and the resistance rates of Acinetobacter baumannii to cefixime and cefotaxime were 7.1% . Methicillin- resistant strains in CNS （MRCNS） and in Staphylococcus aureus （MRSA） accounted for 84.7% and 43.5%, respectively. Vancomycin, linezolid and tigecycline-resistant G~ bacteria were not detected. Conclusion The pathogens isolated from blood culture were widely distributed. Most of them were G- bacteria, and the resistance to antibiotics was

关 键 词：恶性血液病 血流感染 抗药性 

分 类 号：R446.5[医药卫生—诊断学]