2012—2016年血液病患者血流感染病原菌分布及耐药性  

Distribution and antimicrobial resistance of pathogens causing bloodstream infection in patients with hematological diseases in 2012-2016

作　　者：张国扬[1] 吴裕丹[1] 谢双锋[1] 聂大年[1] 黄松音[1] 尹松梅[1] 徐凤琴[1] 马丽萍[1] ZHANG Guo-yang;WU Yu-dan;XIE Shuang-feng;NIE Da-nian;HUANG Song-yin;YIN Song-mei;XU Feng-qin;MA Li-ping(Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院,广东广州510120

出　　处：《中国感染控制杂志》2018年第10期853-859,共7页Chinese Journal of Infection Control

基　　金：广东省自然科学基金项目(S2013010015539)

摘　　要：目的了解血液病患者血流感染的临床特点、病原菌分布和耐药情况,为临床合理使用抗菌药物提供依据。方法回顾性分析2012年1月—2016年12月发生血流感染的血液病患者临床资料,包括感染部位、病原菌种类及对常用抗菌药物的耐药情况等。结果血培养阳性血流感染患者共308例,分离病原菌337株,其中革兰阳性菌119株(35.3%),主要为凝固酶阴性葡萄球菌和肠球菌属;革兰阴性菌215株(63.8%),主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌;真菌3株(0.9%),均为热带假丝酵母菌。血流感染患者分离菌株中革兰阴性菌所占比率逐渐增加,最高达71.6%。大肠埃希菌、肺炎克雷伯菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和碳青霉烯类抗生素的耐药率均<20%。铜绿假单胞菌对阿米卡星、环丙沙星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和碳青霉烯类抗生素的耐药率均<20%。主要革兰阳性菌对万古霉素、替考拉宁、利奈唑胺敏感率接近或达到100%,未检出耐万古霉素肠球菌(VRE)。热带假丝酵母菌对两性霉素B100%敏感。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶菌株检出率分别为55.6%、41.2%。8株金黄色葡萄球菌中检出耐甲氧西林金黄色葡萄球菌5株,60株凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌检出率为86.7%。结论血液病住院患者血流感染病原菌种类较多,革兰阴性菌所占比例呈上升趋势,且多重耐药菌检出率高,应根据不同地区病原菌分布及耐药情况合理选择抗菌药物。Objective To understand clinical characteristics,pathogenic distribution and antimicrobial resistance of bloodstream infection(BSI)in patients with hematological diseases,so as to provide evidence for rational application of antimicrobial agents.Methods Clinical data of hematological patients with BSI from January 2012 to December 2016 were retrospectively analyzed,including infection site,species of pathogens,resistance to commonly used antimicrobial agents and so on.Results A total of 308 patients were with BSI,337 strains of pathogens were isolated from blood culture,119(35.3%)of which were gram-positive bacteria,mainly coagulase-negative staphylococcus and Enterococcus;215 strains(63.8%)were gram-negative bacteria,mainly Escherichia coli(E.coli),Klebsiella pneumoniae(K.pneumoniae),and Pseudomonas aeruginosa(P.aeruginosa);3(0.9%)were fungi,all were Candida tropicalis.The proportion of gram-negative bacteria isolated from patients with BSI increased gradually,up to 71.6%.Resistance rates of E.coli and K.pneumoniae to cefoperazone/sulbactam,piperacillin/tazobactam,and carbapenems were all<20%.Resistance rates of P.aeruginosa to amikacin,ciprofloxacin,cefoperazone/sulbactam,piperacillin/tazobactam,and carbapenems were all<20%.Susceptibility rates of major gram-positive bacteria to vancomycin,teicoplanin,and linezolid were close to or up to 100%,vancomycin-resistant Enterococcus(VRE)was not found.Susceptibility rate of Candida tropicalis to amphotericin B was 100%.The detection rates of extended-spectrumβ-lactamases in E.coli and K.pneumoniae were 55.6%and 41.2%respectively.Five strains of methicillin-resistant Staphylococcus aureus were detected among 8 strains of Staphylococcus aureus,and 86.7%of 60 strains of coagulase-negative staphylococcus were methicillin-resistant staphylococcus.Conclusion There are many kinds of pathogens causing BSI in hospitalized patients with hematological diseases,proportion of gram-negative bacteria has increasing tendency,detection rate of multidrug-resistant organisms is high,ant

关 键 词：血液病 血流感染 病原菌 耐药性 医院感染 

分 类 号：R181.32[医药卫生—流行病学]