血液病移植患者肠道定植病原谱及药敏分析  

Distribution and antimicrobial resistance of intestinal colonization bacteria in patients with hematological transplant

作　　者：吴月圆 徐杰[1] 张险峰[1] 韩清珍[1] 赵丽娜[1] 毛菊珍[1] 钱雪峰[1] 周志英[1] 

机构地区：[1]苏州大学附属第一医院临床检测中心,江苏苏州215006

出　　处：《检验医学与临床》2017年第A02期11-14,共4页Laboratory Medicine and Clinic

基　　金：江苏省卫生厅医学科研项目（Q201401）;江苏省青年医学人才项目（QNRc2016726）;江苏省研究生培养创新工程项目（KYLX1261）;苏州市“科教兴卫”青年课题项目（kjxw2014008）.

摘　　要：目的 了解血液病移植患者肠道定植病原谱特点及耐药性.方法 对苏州大学附属第一医院2016年4~7月血液病患者肛拭子标本分离的定植病原菌分布及耐药性进行分析,采筛选产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌和耐万古霉素的肠球菌.结果 分离到74株细菌,以肠球菌为主,分离最多的是屎肠球菌,占36.5%;产 ESBLs的大肠埃希菌检出率为43. 8%,表现为对头孢唑啉、头孢呋新、头孢噻肟、头孢曲松、头孢哌酮耐药;粪肠球菌对四环素高度耐药,耐药率为75%;屎肠球菌对青霉素G、氨苄西林、环丙沙星高度耐药,耐药率依次为100.0%、100.0%、96.3%;检出2株耐万古霉素的屎肠球菌（VREfm）.结论 血液病移植患者肠道定植病原菌以肠球菌为主,耐药严重的屎肠球菌分离最多,且检出2株VREfm,粪肠球菌与屎肠球菌间表现出不同的耐药类型;革兰阴性菌为大肠埃希菌,产ESBLs的大肠埃希菌较严重;临床和微生物实验室应引起重视,关注移植期多重耐药菌的潜在风险.Objective To invstigate the distribution and antimicrobial resistance of pathogenic bateria from hematological trans-plant patients with Intestinal colonization so as to provide laboratory evidence for rationally selecting antibiotics in clincal practice. Methods The distribution and antimicrobial resistance of pathogenic bateria from hematological patients with Respiratory Tract In-fections during 2016.04 to 2016.07 were analyzed.Results Totally 74 strains of pathogens were isolatd,Enterococcus was the most common pathogenic bacteria,accounting for 36.5%;the detection rates of E.faecium was 70.4%.In E.coli,resistance percent to Cefazolin,Cefuroxime,Cefotaxime,Ceftriaxone and Cefoperazone was higher than 43.8%.The Resistance percent for Tetracy-cline of E.faecalis was 75.0%.The majority of E.faecium isolates were resistant to penicillin G（100.0% ）,ampicillin（100.0% ）, ciprofloxacin（96.3% ）,significantly higher than that of E.faecalis.Two VREfm were isolated.Conclusion In the pathogenic bateria from hematological patients with Intestinal colonization,Enterococcus was the predominant species;E.faecium and ESBLs＋ E.coli showed serious multidrug-resistance,and Two VREfm were isolated;E.faecalis and E.faecium displayed different resistant pro-files.Thus Intestinal swabs bacteria screening is needed for the hospital to pay attention to the potential risk of MDR Intestinal col-onization.

关 键 词：血液病 移植 肠道定植 病原谱 耐药性 

分 类 号：R552[医药卫生—血液循环系统疾病]