血液肿瘤患者血流感染临床耐药性和细菌学分析  

Clinical Drug Resistance and Bacteriological Analysis of Bloodstream Infection in Patients with Hematological Malignancies

作　　者：韩心雨 李丽梅 徐长荣 吕鹏 周倩 王晓亮 王国玲 HAN Xin-yu;LI Li-mei;XU Chang-rong;LYU Peng;ZHOU Qian;WANG Xiao-liang;WANG Guo-ling(Graduate School,Inner Mongolia University of Science and Technology Baotou Medical College,Baotou Inner Mongolia,010040,China;Department of Hematology,People’s Hospital of Inner Mongolia Autonomous Region,Hohhot Inner Mongolia,010017,China;Graduate School,Inner Mongolia Medical University,Hohhot Inner Mongolia,010010,China)

机构地区：[1]内蒙古科技大学包头医学院研究生院,内蒙古包头010040 [2]内蒙古自治区人民医院血液科,内蒙古呼和浩特010017 [3]内蒙古医科大学研究生院,内蒙古呼和浩特010010

出　　处：《中华养生保健》2023年第4期7-11,共5页CHINESE HEALTH CARE

基　　金：内蒙古自治区自然科学基金项目(2019MS08004);内蒙古自治区卫生健康科技计划项目(202201060);2022年度内蒙古医科大学校级项目(YKD2022LH073)。

摘　　要：目的探讨内蒙古自治区人民医院血液肿瘤住院患者发生细菌性血流感染(Blood Stream Infection,BSI)的常见致病菌、临床耐药性及药敏结果,为临床医生抗感染治疗及降低院内获得性感染提供诊疗思路及临床依据。方法收集整理2016年1月—2020年12月内蒙古自治区人民医院收治的194例血液肿瘤合并细菌性血流感染住院患者的血培养标本,具体操作即各抽取194例患者的外周血20 mL,置于细菌培养瓶中,然后置于血培养仪检测并收集阳性标本,将检测到的致病菌利用自动化仪器法以及纸片扩散法进行细菌学分析、临床耐药性及药敏试验等。结果从血培养阳性标本中分离出非重复菌株共197株,其中最多见的为革兰氏阴性菌,共97(49.24%)株,主要为大肠杆菌58(29.45%)株,肺炎克雷伯杆菌20(10.15%)株;其次为革兰氏阳性菌,共57(28.93%)株,主要为表皮葡萄球菌23(11.68%)株,金黄色葡萄球菌11(5.58%)株;真菌2(1.02%)株,其他菌株41(20.81%)株。药敏试验结果显示革兰氏阴性菌对于碳青霉烯类抗菌药物敏感率最高,对氨苄西林最具耐药性;革兰氏阳性菌对糖肽类抗生素利奈唑胺、万古霉素敏感性最高,对青霉素G、红霉素耐药率较高。结论血液肿瘤患者发生BSI的致病菌种类较多,其中主要以革兰氏阴性菌为主,临床中可将美罗培南、亚胺培南等作备选的主要抗菌药物;其次为革兰氏阳性菌感染,所以当发生严重葡萄球菌的血流感染时,可首选利奈唑胺、万古霉素等进行抗菌治疗;而伏立康唑、氟康唑等抗菌药可应用于临床真菌感染的治疗。Objective To investigate the common pathogenic bacteria analysis,clinical drug resistance and drug sensitivity results of bacterial blood stream infection(BSI)in patients with blood tumors in the People’s Hospital of Inner Mongolia Autonomous Region,so as to provide clinicians with diagnosis and treatment ideas and clinical basis for anti infection treatment and reduce hospital acquired infection selection.Methods Collect and sort out the blood culture samples of hospitalized patients(a total of 194 cases)with hematological tumors and bacterial blood flow infection from January 2016 to December 2020 of the Inner Mongolia Autonomous Region People’s Hospital,and the specific operation is to extract 20 mL of peripheral blood from these 194 patients,place it in a bacterial culture bottle,and then place it in a blood culture instrument to detect and collect positive samples.Use the automated instrument method and paper diff usion method to carry out bacteriological analysis,clinical drug resistance and drug sensitivity test for the detected pathogenic bacteria.Results A total of 197 strains were isolated from blood culture positive samples without repetition,of which 97(49.24%)strains were gram-negative bacteria,mainly 58(29.45%)strains of Escherichia coli and 20(10.15%)strains of Klebsiella pneumoniae;The second was Gram positive bacteria,with 57(28.93%)strains,mainly including 23(11.68%)strains of Staphylococcus epidermidis and 11(5.58%)strains of Staphylococcus aureus;There were 2(1.02%)fungi and 41(20.81%)other strains.The results of drug sensitivity test showed that Gram negative bacteria had the highest sensitivity to carbapenem antibiotics and the highest resistance to ampicillin;Gram positive bacteria had the highest sensitivity to glycopeptide antibiotics linezolid and vancomycin,and high resistance to penicillin G and erythromycin.Conclusion There are many types of pathogenic bacteria with BSI in patients with hematological tumors,mainly gram-negative bacteria,and meropenem and imipernam can be used as a

关 键 词：血液肿瘤 血流感染 耐药性 病原菌 

分 类 号：R55[医药卫生—血液循环系统疾病]