恶性血液病患者合并下呼吸道感染的病原菌分布及耐药性单中心分析  

Pathogen distribution and antimicrobial resistance among lower respiratory tract infections in patients with hematological malignancies

作　　者：任娟[1] 康建邦[2] 马艳萍[1] 张建华[1] 董春霞[1] 康建民[1] 张睿娟[1] 王梅芳[1] 葛晓燕[1] 杨林花[1] Ren Juan;Kang Jianbang;Ma Yanping;Zhang Jianhua;Dong Chunxia;Kang Jianmin;Zhang Ruijuan;Wang Meifang;Ge Xiaoyan;Yang Linhua(Department of Hematology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Pharmacy,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院血液科,太原030001 [2]山西医科大学第二医院药学部,太原030001

出　　处：《中华内科杂志》2021年第10期875-879,共5页Chinese Journal of Internal Medicine

摘　　要：目的探讨恶性血液病患者下呼吸道感染的病原菌分布及常用抗菌药物的耐药性,为临床经验性抗感染治疗提供参考。方法收集山西医科大学第二医院血液科2017年1月至2020年7月收治的合并下呼吸道感染的恶性血液病患者967例的痰标本,采用全自动细菌鉴定仪进行细菌鉴定及药敏试验,分析患者的诊断、临床特征、病原菌及药敏试验结果。采用WHONET 5.6和SPSS 20.0软件进行统计学分析。结果共分离出病原菌961株,革兰阴性菌516株(53.7%),分离的主要菌株依次为:肺炎克雷伯菌118株(12.3%)、铜绿假单胞菌68株(7.1%)、鲍曼不动杆菌67株(7.0%)、嗜麦芽窄食单胞菌52株(5.4%)、大肠埃希菌43株(4.5%)、阴沟肠杆菌42株(4.4%);革兰阳性菌171株(17.8%),真菌274株(28.5%)。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类耐药率为22.1%~31.3%。嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明和米诺环素敏感。3种肠杆菌对碳青霉烯类、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率低(<10%)。未检出对替考拉宁、万古霉素、利奈唑胺耐药的革兰阳性菌。结论本区域单中心恶性血液病患者下呼吸道感染病原菌仍以革兰阴性菌为主,不同病原菌对常用抗菌药物的耐药情况不同。Objective To investigate the pathogen distribution and antimicrobial resistance among lower respiratory tract infections in patients with hematological malignancies.Methods Sputum samples were collected from 967 patients with hematological malignancies and lower respiratory tract infections in Department of Hematology,the Second Hospital of Shanxi Medical University from January 2017 to July 2020.The pathogens and drug sensitivity reports were carried out by automatic bacterial identification instruments.WHONET 5.6 and SPSS 20.0 softwares were used for statistical analysis.Results A total of 961 strains of pathogens were isolated,516(53.7%)pathogens were Gram-negative bacteria,mainly 118 strains of Klebsiella pneumonia(12.3%),68 strains of Pseudomonas aeruginosa(7.1%),67 strains of Acinetobacter baumannii(7.0%),52 strains of Stenotrophomonas maltophilia(5.4%),43 strains of Escherichia coli(4.5%),and 42 strains of Enterbacter cloacae(4.4%).There were 171(17.8%)strains of Gram-positive bacteria and 274(28.5%)fungi.The drug resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenem were 22.1%-31.3%.Stenotrophomonas maltophilia was sensitive to levofloxacin,compound sulfamethoxazole and minocycline.The antimicrobial resistance rates of these three enterobacteria to carbapenems,cefoperazone/sulbactam,piperacillin/tazobactam were low(<10%).The resistant Gram-positive bacteria to ticoplanin,vancomycin and linazolamide were not detected.Conclusion The major pathogens related to lower respiratory tract infections in patients with hematological malignancies are gram-negative bacteria in our centre.Different pathogens appear different characteristics of antimicrobial resistance.

关 键 词：血液病 呼吸道感染 病原 抗药性 

分 类 号：R446.5[医药卫生—诊断学] R733[医药卫生—临床医学] R56