上海地区粒细胞缺乏伴肺部感染血液病患者呼吸道分离细菌及耐药性多中心回顾性研究  

A multicenter retrospective study on isolation and drug resistance of pathogens isolated from respiratory tract in hematological patients with agranulocytosis accompanied by pulmonary infection in Shanghai

作　　者：李志超[1] 朱骏[2] 王椿[2] 胡炯[3] 毛原飞[3] 陈芳源[4] 朱坚轶[4] 刘澎 顾史洋 施菊妹[6] 刘银梅[6] 梁爱斌[7] 丁懿[7] 侯健 何海燕 刘立根 谢英华 朱琦[10] 俞夜花[10] 姚永华[11] 陈蔚[11] 许惠利 韩秀华 郝思国[1] LI Zhi-chao;ZHU Jun;WANG Chun;HU Jiong;MAO Yuan-fei;CHEN Fang-yuan;ZHU Jian-yi;LIU Peng;GU Shi-yang;SHI Ju-mei;LIU Yin-mei;LIANG Ai-bin;DING Yi;HOU Jian;HE Hai-yan;LIU Li-gen;XIE Ying-hua;ZHU Qi;YU Ye-hua;YAO Yong-hua;CHEN Wei;XU Hui-li;HAN Xiu-hua;HAO Si-guo(Department of Hematology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Hematology,Shanghai General Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200080,China;Department of Hematology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Hematology,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200135,China;Department of Hematology,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Hematology,Shanghai Tenth People’s Hospital Affilia-ted to Tongji University,Shanghai 200072,China;Department of Hematology,Tongji Hospital Affiliated to Tongji University,Shanghai 200333,China;Department of Hematology,Shanghai Changzheng Hospital,Shanghai 201705,China;Department of Hematology,The Fifth People’s Hospital of Shanghai,Fudan University,Shanghai 200240,China;Department of Hematology,The Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Hematology,Shanghai Yangpu District East Hospital,Shanghai 200433,China;Department of Hematology,Shanghai Jiading District Central Hospital,Shanghai 201807,China)

机构地区：[1]上海交通大学医学院附属新华医院血液科,上海200092 [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200135 [5]复旦大学附属中山医院血液科,上海200032 [6]同济大学附属第十人民医院血液科,上海200072 [7]同济大学附属同济医院血液科,上海200333 [8]上海长征医院血液科,上海201705 [9]复旦大学附属上海市第五人民医院血液科,上海200240 [10]上海交通大学医学院附属第九人民医院血液科,上海200011 [11]上海市杨浦区市东医院血液科,上海200433 [12]上海市嘉定区中心医院血液科,上海201807

出　　处：《中国感染控制杂志》2019年第11期1025-1031,共7页Chinese Journal of Infection Control

摘　　要：目的了解上海地区中性粒细胞缺乏(粒缺)伴肺部感染血液病患者呼吸道分泌物检出病原菌的分布及耐药情况。方法回顾性收集2012年1月-2014年12月上海市12所医院血液科粒缺伴肺部感染住院患者呼吸道分泌物分离菌株的临床资料、药敏结果,分析病原菌分布及其药敏数据,比较不同原发疾病病原菌分布之间的差异。结果共分离病原菌623株,其中革兰阳性菌138株(22.2%),革兰阴性菌485株(77.8%),非发酵菌占革兰阴性菌的60.2%(292株)。淋巴瘤患者标本中分离革兰阳性菌构成比(35.0%)高于急性髓系白血病和急性淋巴细胞白血病患者。居前5位的细菌分别是嗜麦芽窄食单胞菌(104株,16.7%)、肺炎克雷伯菌(88株,14.1%)、鲍曼不动杆菌(62株,10.0%)、铜绿假单胞菌(56株,9.0%)、金黄色葡萄球菌(48株,7.7%)。肺炎克雷伯菌对碳青霉烯类抗生素敏感率>98%,铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为24.3%、8.9%,嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素、复方磺胺甲口恶唑敏感率>90%,鲍曼不动杆菌对阿米卡星、头孢哌酮/舒巴坦的耐药率低于10%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为71.4%,未发现耐万古霉素、替考拉宁、利奈唑胺的金黄色葡萄球菌。结论粒缺伴肺部感染患者呼吸道分泌物分离菌株以革兰阴性菌占多数,其中非发酵菌占50%以上,细菌耐药率整体低于CHINET全国医院大样本监测结果。Objective To investigate the distribution and drug resistance of pathogens isolated from respiratory secretion of hematological patients with agranulocytosis accompanied by pulmonary infection in Shanghai.Methods Clinical data and drug susceptibility result of bacteria isolated from respiratory secretion of hospitalized patients with agranulocytosis and pulmonary infection in departments of hematology in 12 hospitals of Shanghai between January 2012 and December 2014 were retrospectively collected,distribution of pathogenic bacteria and drug susceptibility data were analyzed,difference among pathogenic bacteria in different primary diseases was compared.Results A total of 623 strains of pathogenic bacteria were isolated,138(22.2%)of which were gram-positive bacteria,485(77.8%)were gram-negative bacteria,60.2%of(292 strains)gram-negative bacteria were non-fermentative bacteria.Constituent ratio of gram-positive bacteria isolated from patients with lymphoma(35.0%)was higher than patients with acute myeloid leukemia and acute lymphoblastic leukemia.The top five bacteria were Stenotrophomonas maltophilia(104 strains,16.7%),Klebsiella pneumoniae(88 strains,14.1%),Acinetobacter baumannii(62 strains,10.0%),Pseudomonas aeruginosa(56 strains,9.0%)and Staphylococcus aureus(48 strains,7.7%).Susceptibility rate of Klebsiella pneumoniae to carbapenems was>98%,resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 24.3%and 8.9%respectively,susceptibility rate of Stenotrophomonas maltophilia to levofloxacin,minocycline and compound sulfamethoxazole was more than 90%,resistance rate of Acinetobacter baumannii to amikacin,cefoperazone/sulbactam was less than 10%.Isolation rate of methicillin-resistant Staphylococcus aureus was 71.4%,no vancomycin-resistant,teicoplanin-resistant and linezolid-resistant Staphylococcus aureus were found.Conclusion Gram-negative bacteria accounts for the majority of isolates from respiratory secretion of patients with agranulocytosis and pulmonary infection,non-fermentative bacteri

关 键 词：中性粒细胞缺乏 发热 肺部感染 细菌 耐药性 

分 类 号：R181.32[医药卫生—流行病学]