海南热带地区恶性血液病患者肺部真菌和其他病原菌感染特征单中心分析  

Single Center Analysis of Pathogenic Characteristics of Lung Candida Infection and Other Pathogenic Bacteria Infection in the Patients with Hemotological Maliglancies in the Tropical Region of Hainan

作　　者：王美璐 匡慧慧 程龙灿 许玉冰 赵婷媛[1] 杨婷[1] 项松鹤[1] 舒成园 于苹 窦立萍[1] 薄剑[1] WANG Mei-Lu;KUANG Hui-Hui;CHENG Long-Can;XU Yu-Bing;ZHAO Ting-Yuan;YANG Ting;XIANG Song-He;SHU Cheng-Yuan;YU Ping;DOU Li-Ping;BO Jian(Department of Hematology, Hainan Branch of the General Hospital of the Chinese PLA, Sanya 572000, Hainan Province, Chin)

机构地区：[1]解放军总医院海南分院血液科,海南三亚572000

出　　处：《中国实验血液学杂志》2018年第3期911-916,共6页Journal of Experimental Hematology

基　　金：北京市自然科学基金(7102147;7172200;7132217);海南自然科学基金(817351);三亚市医疗卫生科技创新项目(2016YW23)

摘　　要：目的:分析热带地区恶性血液病住院患者有呼吸道症状的群体中痰及静脉血培养的病原菌感染的特点,并观察其耐药性,为临床治疗提供病原学依据。方法:回顾性分析2013年1月--2017年11月本院血液科2 466例恶性血液病患者出现呼吸道症状群体中病原菌及其耐药性。送检标本来源为痰、静脉血。结果:患者痰标本培养显示,检出菌株224株,其中真菌在热带地区血液病患者检出率最高,共98株(43.75%),主要为白色念珠菌41株;其次是革兰阴性菌株88株(39.28%),主要致病菌为大肠埃希菌(22株)、肺炎克雷伯杆菌(12株);再次为革兰阳性菌38株(16.96%),主要致病菌依次为肠球菌属(14株)、革兰阳性杆菌(14株)。海南患者血培养检出菌株61株,其中革兰阳性菌最高,共34株(55.74%),主要为人葡萄球菌人亚种(19株),革兰氏阴性菌27株(44.26%),主要致病菌为肺炎克雷伯菌(12株)。革兰阴性菌对替加环素、亚胺培南西司他丁纳,哌拉西林钠他唑巴坦钠的药物耐药率最低,而革兰阳性致病菌肠球菌属、革兰阳性杆菌、金黄色葡萄球菌对万古霉素,替加环素、利奈唑胺均敏感。结论:热带地区血液病患者为医院感染的易感人群;痰培养结果显示,真菌是恶性血液病患者呼吸道主要致病菌,区别于华北及其它北方地区,热带地区临床医生应根据病原菌的特点选择合适抗生素进行抗感染治疗。Objective：To analyze the infection characteristics of sputum and venous blood pathogen in the patients with hematological malignancies and respiratory symptom in the Hematology Department in tropical region and to investigate its drug-resistance so as to provide etiological evidence for clinical treatment.Methods： The pathogens and their drug-resistance of 2466 samples in the patients with hematological malignancies and respiratory symptom in the Department were analyzed retrospectively from January 2013 to November 2017.The samples were collected from sputum and venous blood.Results： The sputum sample culture in patients with hematologic diseases showed that 224 strains were isolated,out of them 98 strains（43.75%） were fungi mainly candida albicans（41 strains）; and then 88 Gram-negative strains（ 39.28%）,among them the main pathogenic bacteria were Escherichia coli（ 22 strains） and klebsiella Klebsiella pneumoniae（ 12 strains）; and then 38 Gram-positive strains（ 16.96%）,among them the main pathogeni-bacteria were Enteroccocus（14 strains） and Gram-positive bacilli（14 strains）.The blood samples culture of patients with hematologic diseases showed that 61 strains were isolated,out of them the isolated rate of Gram-positive bactetia was higherst,which accounted for 55.74%（34/61）,mainly including staphylococcus lominis（19 strains）; and the isolated rate of Gram-negative bacteria was 44.26%（27/61）,among them main pathogenic bacteria was Klebsiella pneumoniae（12 strains）.The resistance test of pathogenic bacteria to drugs showed that the resistant rate of Gram-negative bacteria to tigecycline,imipenem and atl-962 duenner was lowest,while the Gram-positive pathogenic bacteria such as Enterococcus,Gram-positive bacilli and Staphylococcus aureus were sensitive to vancomycin,tigecycline and linezolid was high.Conclusion： the patients in hematology department are infected easily in the hospital in tropical region.The main pathogens are fungal strains in the respiratory

关 键 词：热带地区 血液疾病 真菌感染 细菌感染 耐药菌 

分 类 号：R733[医药卫生—肿瘤] R378[医药卫生—临床医学]