急性白血病化疗后中性粒细胞缺乏患者血流感染的病原菌分布及耐药性特征分析  

Analysis of pathogenic bacteria distribution and drug resistance characteristics of bloodstream infection in patients with neutrophilic deficiency after chemotherapy in acute leukemia

作　　者：徐海琳 张智洁[1,2] 徐资涵 刘勇 秦晓松[1,2] XU Hai-lin;ZHANG Zhi-jie;XU Zi-han;LIU Yong;QIN Xiao-song(Department of Laboratory Medicine,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China;Liaoning Clinical Research Center for Laboratory Medicine,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院检验科,辽宁沈阳110004 [2]辽宁省医学检验临床医学研究中心,辽宁沈阳110004

出　　处：《中国热带医学》2022年第11期1009-1014,共6页China Tropical Medicine

基　　金：国家科技基础资源调查专项(No.2019FY101200);辽宁省自然科学基金(No.2020-MS-10)。

摘　　要：目的 了解急性白血病(acute leukemia, AL)化疗后中性粒细胞缺乏患者血流感染(bloodstream infection,BSI)的病原菌分布及耐药性特征,为临床及时合理选择抗菌药物、制定合理给药方案提供参考依据。方法 收集2016年1月—2021年12月中国医科大学附属盛京医院收治的AL患者化疗后中性粒细胞缺乏期经血培养确诊发生血流感染258例,对患者临床资料、病原菌及药敏结果进行分析。结果 258例患者分离病原菌268株,其中革兰阴性菌180株(67.16%),革兰阳性菌61例(22.76%),真菌27株(10.07%);革兰阴性菌以肺炎克雷伯菌(53/268,19.78%)、大肠埃希菌(49/268,18.28%)、铜绿假单胞菌(41/268,15.30%)为主;革兰阳性菌以凝固酶阴性葡萄球菌(31/268,11.57%)、金黄色葡萄球菌(17/268,6.34%)为主;真菌以热带念珠菌(25/268,9.33%)为主;急性髓细胞白血病(AML)分离病原菌以大肠埃希菌(33/268,12.31%)常见,其次为铜绿假单胞菌(25/268,9.33%)、凝固酶阴性葡萄球菌(18/268,6.72%)和热带念珠菌(18/268,6.72%);急性淋巴细胞白血病(ALL)分离病原菌以肺炎克雷伯菌(35/268,13.06%)常见,其次为铜绿假单胞菌(15/268,5.60%)和大肠埃希菌(14/268,5.22%)。革兰阴性菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南、美罗培南、厄他培南、阿米卡星、头孢西丁、阿莫西林/克拉维酸耐药性低;革兰阳性球菌对利奈唑胺和万古霉素均敏感;念珠菌对5-氟胞嘧啶、两性霉素B、伊曲康唑均敏感。结论 AL化疗后粒缺患者合并BSI中,AML分离病原菌种类多样,ALL分离病原菌主要以革兰阴性菌为主,病原菌对常用抗菌药物均有不同程度的耐药,加强监测病原菌分布和耐药性的变化,合理使用抗菌药物,最大限度减少患者的死亡。ObjectiveTo investigate the distribution and drug resistance characteristics of pathogenic bacteria inpatients with neutropenic acute leukemia(AL) and bloodstream infections(BSI).MethodsThe clinical data of 258neutropenic acute leukemia patients with bloodstream infections, who admitted to Shengjing Hospital of China MedicalUniversity from January 2016 to December 2021, were collected and analyzed for pathogenic bacteria and drug resistance.ResultsA total of 268 strains of pathogenic bacteria were isolated from 258 patients, including 180 strains of gram-negativebacteria(67.16%), 61 strains of gram-positive bacteria(22.76%), and 27 strains of fungi(10.07%). Gram-negative bacteriawere mainly Klebsiella pneumoniae(53/268, 19.78%), Escherichia coli(49/268, 18.28%) and Pseudomonas aeruginosa(41/268,15.30%). Gram-positive bacteria were mainly coagulase negative Staphylococcus(31/268, 11.57%) and Staphylococcus aureus(17/268, 6.34%). The main fungi were Candida tropicalis(25/268, 9.33%). Escherichia coli(33/268, 12.31%) was the mostcommon pathogen isolated from acute myeloid leukemia(AML), followed by Pseudomonas aeruginosa(25/268, 9.33%),coagulase-negative Staphylococcus(18/268, 6.72%) and Candida tropicalis(18/268, 6.72%). Klebsiella pneumoniae(35/268,13.06%) was the most common pathogen isolated from acute lymphoblastic leukemia(ALL), followed by Pseudomonas aeruginosa(15/268, 5.60%) and Escherichia coli(14/268, 5.22%). The resistance of Gram-negative bacteria to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, meropenem, ertapenem, amikacin, cefoxitin, amoxicillin/clavulanic acid waslow. Gram-positive bacteria were sensitive to linezolid and vancomycin. Candida was sensitive to flucytosine, amphotericin B and itraconazole.ConclusionsIn patients with granulosa after AL chemotherapy combined with BSI, the pathogenic bacteriaisolated from AML are diverse, and the pathogenic bacteria isolated from ALL are mainly gram-negative bacteria. Pathogenicbacteria have different degrees of drug resistance to commonly u

关 键 词：急性白血病 中性粒细胞缺乏 血流感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]