上海多家三甲医院中性粒细胞缺乏伴发热淋巴瘤患者病原菌分布及耐药性分析  

Analysis of pathogenic bacteria distribution and antibiotics resistance in febrile neutropenic patients with lymphoma in several tertiary hospitals in Shanghai

作　　者：励菁菁[1] 朱琦[1] 王椿[2] 胡炯[3] 陈芳源[4] 施菊妹[5] 郝思国[6] 刘澎 俞夜花[1] LI Jing-jing;ZHU Qi;WANG Chun;HU Jiong;CHEN Fang-yuan;SHI Ju-mei;HAO Si-guo;LIU Peng;YU Ye-hua(Department of Hematology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Hematology,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong UniversitySchool of Medicine,Shanghai 200025,China;Department of Hematology,Renji Hospital,Shanghai Jiao TongUniversity School of Medicine,Shanghai 200127,China;Department of Hematology,Shanghai Tenth People'sHospital,Tongji University,Shanghai 200072,China;Department of Hematology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Hematology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海交通大学医学院附属第九人民医院血液科,上海200011 [2]上海交通大学附属第一人民医院血液科,上海200080 [3]上海交通大学医学院附属瑞金医院血液科,上海200025 [4]上海交通大学医学院附属仁济医院血液科,上海200127 [5]同济大学附属第十人民医院血液科,上海200072 [6]上海交通大学医学院附属新华医院血液科,上海200092 [7]复旦大学附属中山医院血液科,上海200032

出　　处：《复旦学报（医学版）》2019年第2期199-204,216,共7页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81500081)~~

摘　　要：目的探讨中性粒细胞缺乏(粒缺)伴发热淋巴瘤患者致病菌的分布及其耐药现状,为临床有效控制感染和合理选用抗生素提供依据。方法回顾性分析2012年1月至2014年12月上海12家三甲医院血液科收治的粒缺伴发热淋巴瘤患者的病原菌分布及药敏特点。结果 108株临床分离菌中革兰阴性(G^-)菌67株,占62.04%;革兰阳性(G^+)菌41株,占37.96%。G^-菌中肠杆菌科细菌最多,占全部致病菌的34.26%(37株);G^+菌中葡萄球菌属最多,占全部致病菌的24.07%(26株)。所有致病菌感染部位以呼吸道分布最多,共60株,占所有标本的55.56%,其次为伤口分泌物19株(17.59%)、导管12株(11.11%)、血液10株(9.26%)、其他标本7株(6.48%)。呼吸道分泌物培养出的菌株以肺炎克雷伯杆菌居多,伤口标本则为产酸克雷伯杆菌,导管以大肠埃希菌多见,而血液标本则以葡萄球菌感染为主。G^+菌对青霉素、红霉素、左氧氟沙星、头孢菌素及庆大霉素类抗生素均不同程度耐药,但对磷霉素、万古霉素、替考拉宁及利奈唑胺敏感度可达92.9%～100%。G^-菌对部分青霉素及头孢菌素类抗生素耐药率较高之外,对阿米卡星、美罗培南、亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等抗生素均较敏感。结论粒缺伴发热淋巴瘤患者致病菌仍以G^-菌为主,分布较为广泛,多药耐药情况严重。利奈唑胺、万古霉素、替考拉宁等仍可作为G^+菌感染的经验性用药;亚胺培南、美罗培南、阿米卡星等可作为G^-菌感染的用药选择。Objective To investigate pathogenic bacteria distribution and antibiotics resistance in febrile neutropenic patients with lymphoma which might provide rationale for optimizing drug selection in improving the outcome of anti-infection therapy.Methods Pathogenic bacteria isolated from febrile neutropenic patients with lymphoma hospitalized in the departments of hematology in 12 Shanghai tertiary hospitals from Jan.,2012 to Dec.,2014 were retrospectively identified and systemically analyzed for its distribution and characteristics of antibiotics resistance.Results A total of 108 clinical isolates were collected from the febrile neutropenic patients with lymphoma,including 41 Gram-positive(G^+)and 67 Gram-negative(G^-)bacteria accounted for 37.96%and 62.04%,respectively.Enterobacteriaceae was the most common G^-bacteria accounted for 34.26%,while Staphylococcus was ranked in the first of all G^+pathogens accounted for 24.07%.The majority of pathogenic bacteria were clinically isolated from respiratory tract secretions specimens added up to 60 isolates accounted for 55.56%,followed by strains isolated from wound and catheter secretions as well as blood amounted to 19,12 and 10 isolates accounted for 17.59%,11.11%and 9.26%,respectively.Klebsiella pneumonia and Klebsiella acid were the most common strains isolated from respiratory tract and wound secretions specimens,while Escherichia coli and Staphylococcal were mainly isolated from catheter and blood samples.G+bacteria were found to some extent be resistant to penicillin,erythromycin,levofloxacin,cephalosporins as well as gentamicin,while sensitivity rate of G^+strains to fosfomycin,vancomycin,teicoplanin and linezolid were approximately around 92.9%-100%.Meanwhile,G^-pathogens were shown to be sensitive to amikacin,meropenem,imipenem,cefoperazone/shubatan and piperacillin/tazobactam despite being resistant to penicillin and cephalosporins.Conclusions G^-bacteria were the most common pathogens in febrile neutropenic patients with lymphoma,among which being multidrug r

关 键 词：淋巴瘤 中性粒细胞减少 发热 细菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R733.4[医药卫生—临床医学]