中性粒细胞缺乏伴发热骨髓衰竭患者的病原菌分布及药敏情况分析  

Bacterial species and antimicrobial susceptibility profile of pathogens in bone marrow failure patients with febrile neutropenia

作　　者：叶成林[1] 陈蔚[2] 姚永华[1] 王椿[3] 李军民[4] 陈芳源[5] 施菊妹[6] 郝思国[7] 刘澎 侯建[9] 梁爱斌[10] 刘立根 朱琦[12] 韩秀华 YE Chenglin;CHEN Wei;YAO Yonghua;WANG Chun;LI Junmin;CHEN Fangyuan;SHI Jumei;HAO Siguo;LIU Peng;HOU Jian;LIANG Aibing;LIU Ligeng;ZHU Qil;HAN Xiuhua(Department of Hematology,Shidong Hospital of Yangpu District,Shanghai 200082,China;Department of Pharmacy,Shidong Hospital of Yangpu District,Shanghai 200082,China;Department of Hematology,First People's Hospital Affiliated of Shanghai Jiao Tong University,Shanghai 200080,China;Department of Hematology,Ruijin Hospital Affiliated of Shanghai Jiao Tong University,Shanghai 200020,China;Department of Hematology,Renji Hospital Affiliated of Shanghai Jiao Tong University,Shanghai 200001,China;Department of Hematology,Tenth People's Hospital of Tongji University,Shanghai 200040,China;Department of Hematology,Xinhua Hospital Affiliated of Shanghai Jiao Tong University,Shanghai 200092,China;Department of Hematology,Zhongshan Hospital of Fudan University,Shanghai 200032,China;Department of Hematology,Shanghai Changzheng Hospital of the Second Military Medical University,Shanghai 200001,China;Department of Hematology,Tongji Hospital of Tongji University,Shanghai 200333,China;Department of Hematology,Shanghai Fifth People's Hospital,Fudan University,Shanghai 201100,China;Department of Hematology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China;Department of Hematology,Jiading Central Hospital,Shanghai 201800,China)

机构地区：[1]上海市杨浦区市东医院血液科,上海200082 [2]上海市杨浦区市东医院药剂科,上海200082 [3]上海交通大学附属上海市第一人民医院血液科,上海200080 [4]上海交通大学附属瑞金医院血液科,上海200020 [5]上海交通大学附属仁济医院血液科,上海200001 [6]同济大学附属上海市第十人民医院血液科,上海200040 [7]上海交通大学附属新华医院血液科,上海200092 [8]复旦大学附属中山医院血液科,上海200032 [9]第二军医大学长征医院血液科,上海200001 [10]同济大学附属同济医院血液科,上海200333 [11]复旦大学附属上海市第五人民医院血液科,上海201100 [12]上海交通大学附属上海市第九人民医院血液科,上海200001 [13]上海市嘉定区中心医院血液科,上海201800

出　　处：《检验医学与临床》2019年第24期3596-3599,3602,共5页Laboratory Medicine and Clinic

基　　金：上海市杨浦区卫生和计划生育委员会中医药专项课题（YP17ZM03）;上海市综合医院中西医结合专项（ZHYY-ZXYJHZX-2-19）

摘　　要：目的探讨中性粒细胞缺乏(粒缺)伴发热骨髓衰竭患者标本中病原菌分布及其耐药性情况。方法回顾性分析2012年1月至2015年1月上海市12家医院血液科1260例粒缺伴发热骨髓衰竭患者标本中的病原菌分布特点及其药敏结果。采用纸片扩散法(K-B)检测分离菌株的药敏情况。采用WHONET5.6软件分析菌株的构成及药敏特点。结果共检出阳性菌174株,其中革兰阴性菌102株(58.6%),革兰阳性菌72株(41.4%)。排名前5位的病原菌分别为肺炎克雷伯菌(13.8%)、大肠埃希菌(9.2%)、铜绿假单胞菌(6.9%)、缓症链球菌(6.9%)、嗜麦芽窄食单胞菌(6.9%)。肠杆菌对氨苄西林、头孢呋辛、复方磺胺甲噁唑-甲氧苄啶等耐药率高(>60.0%);非发酵菌除对氨苄西林耐药率高(88.2%)以外,对其他药物的耐药率均低于50.0%。检出2株耐甲氧西林金黄色葡萄球菌及24株耐甲氧西林凝固酶阴性葡萄球菌;肠球菌对氨苄西林和左氧氟沙星耐药率较高(≥60.0%);未检出对利奈唑胺耐药的葡萄球菌和肠球菌。结论粒缺伴发热的骨髓衰竭患者致病菌以革兰阴性菌为主,肠杆菌和非发酵菌常见,且肠杆菌耐药情况较严重。葡萄球菌、肠球菌及肠杆菌的耐药情况均值得重视。Objective To examine the distribution of bacterial species and antimicrobial susceptibility profile of pathogens in bone marrow failure patients with febrile neutropenia.Methods A total of 1260 bone marrow failure patients with febrile neutropenia were collected in 12 hospitals from January 2012 to January.2015.Distribution characteristics and drug sensitivity of clinical isolates were retrospectively analyzed.Kirby-Bauer method was used to test the drug sensitivity of clinical isolates.WHONET5.6 was used to analyze the distribution of bacterial species and drug sensitivity of clinical isolates.Results A total of 174 strains were isolated.Gram-negative bacteria accounted for 58.6%,while gram-positive bacteria accounted for 41.4%.The most common bacterial species were Klebsiella pneumonia(13.8%),Escherichia coli(9.2%),Pseudomonas aeruginosa(6.9%),Streptococcus mitis(6.9%),Stenotrophomonas maltophilia(6.9%).The resistance rates of Enterobacteriaceae resistant to ampicillin,cefuroxime,com pound sulfamethoxazole trimethoprim were higher(>60.0%).Except ampicillin(the resistance rate was higher to 88.2%),the resistance rates of non-fermentative bacteria to other drugs were lower than 50.0%.There were two strains of Methicillin resistant Staphylococcus aureus and 24 strains of Methicillin resistant coagulase negative Staphylococcus.The resistance rates of Enterococcus to ampicillin and levofloxacin were higher than 60.0%.There were no Staphylococcus and Enterococcus resistant to linezolid.Conclusion Gram-negative bacteria,especially Enterobacteriaceae and Non-fermentativebacteria,are still the primary pathogens in bone marrow failure patients with febrile neutropenia.And drug resistance to the Enterobacteriaceae is serious,which should be paid more attention as well as to the Staphylococcus.

关 键 词：中性粒细胞缺乏 发热 骨髓衰竭 细菌耐药性 

分 类 号：R559[医药卫生—血液循环系统疾病]