白血病患儿血培养病原菌分布、耐药特征及死亡危险因素  

Distribution,antimicrobial resistance of pathogens from blood culture,and risk factors for death of children with leukemia

作　　者：刘宁[1] 赵娟[1] 李艳明[1] 晏群[1] 钟一鸣[1] 杨芳[1] 刘文恩[1] LIU Ning;ZHAO Juan;LI Yan-ming;YAN Qun;ZHONG Yi-ming;YANG Fang;LIU Wen-en(Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院,湖南长沙410008

出　　处：《中国感染控制杂志》2018年第4期277-282,共6页Chinese Journal of Infection Control

基　　金：国家自然科学基金资助项目(81672066)

摘　　要：目的观察白血病患儿血培养病原菌分布及耐药情况,研究其危险因素。方法对某医院2013年9月—2016年11月小儿血液专科病房内110例患儿血培养分离的131株病原菌种类、耐药类型,以及患儿临床资料进行统计分析。结果2 505份血培养送检标本中共培养病原菌131株(5.23%),其中革兰阴性杆菌占52.67%,革兰阳性球菌占43.51%,分离居前3位的依次为大肠埃希菌(15.27%)、肺炎克雷伯菌(15.27%)和人葡萄球菌(12.98%)。革兰阴性杆菌对氨苄西林、头孢唑林、头孢曲松及氨苄西林/舒巴坦耐药性高,对阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及碳青霉烯类敏感性较好;革兰阳性球菌对青霉素、苯唑西林、红霉素和克林霉素耐药性较高,对替加环素、利奈唑胺、万古霉素和奎奴普丁/达福普汀敏感性较好。单因素分析结果显示,混合感染、腹泻、铜绿假单胞菌感染以及鲍曼不动杆菌感染与白血病血流感染患儿病死率相关。结论白血病患儿血流感染病原菌分布广泛,耐药率高,积极预防和根据药敏结果进行合理治疗十分重要。Objective To observe distribution and antimicrobial resistance of pathogens from blood culture of children with leukemia,and study risk factors.Methods From September 2013 to November 2016,species and antimicrobial resistance types of 131 strains of pathogens isolated from blood culture of 110 children in a pediatric hemato-logy ward were analyzed,childrens’clinical data were also analyzed statistically.Results 131 strains(5.23%)of pathogens were isolated from 2 505 blood culture specimens,gram-negative bacilli and gram-positive cocci accounted for 52.67%and 43.51%respectively,the top 3 pathogens were Escherichia coli(15.27%),Klebsiella pneumoniae(15.27%),and Staphylococcus hominis(12.98%).Gram-negative bacilli were highly resistant to ampicillin,cefazolin,ceftriaxone,and ampicillin/sulbactam,but sensitive to amikacin,cefoperazone/sulbactam,piperacillin/tazobactam,and carbapenems;gram-positive cocci had higher resistance to penicillin,oxacillin,erythromycin,and clindamycin,but were sensitive to tigecycline,linezolid,vancomycin,and quinupristin/dalfopristin.Univariate analysis showed that mixed infection,diarrhea,Pseudomonas aeruginosa infection,and Acinetobacter baumannii infection were related to mortality due to bloodstream infection in children with leukemia.Conclusion Pathogens causing bloodstream infection in children with leukemia is widely distributed,antimicrobial resistance rate is high,it is very important to take active precaution and rational treatment according to antimicrobial susceptibility testing result.0x09

关 键 词：儿童 白血病 血培养 耐药性 抗药性 微生物 死亡危险因素 

分 类 号：R733.7[医药卫生—肿瘤]