血液病患者血流感染特征及危险因素分析  

Infection characteristics and risk factors of bloodstream infection in patients with hematological diseases

作　　者：谢瑜[1] 黎承平[1] 李德云[1] 谭琳[1] XIE Yu;LI Cheng-ping;LI De-yun;TAN Lin(The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院,云南昆明650032

出　　处：《中国病原生物学杂志》2023年第4期478-481,485,共5页Journal of Pathogen Biology

摘　　要：目的分析血液病患者并发血流感染的病原菌分布特点及危险因素。方法选取2021年1月~2021年12月于本院血液内科发生血流感染的血液病患者150例,同时随时选取同期60例未发生血流感染的血液病患者。收集所有参与本次研究患者的临床资料,包括年龄、患病类型、住院天数、中性粒细胞值、粒细胞缺乏时间、治疗方式、病原菌检出情况及药敏试验结果等,分析血液病患者发生血流感染的危险因素。血液病患者疑似发生血流感染后,在使用抗菌药物治疗前,抽取患者外周静脉血于血培养瓶内,采用全自动血培养仪进行细菌培养,采用全自动细菌鉴定仪进行病原菌鉴定及药敏试验。结果150例发生血流感染的血液病患者,共检出病原菌148株。其中革兰阴性菌93株,革兰阳性菌44株,真菌11株。革兰阴性菌主要为肺炎克雷伯菌(21.62%),大肠埃希菌(16.22%),铜绿假单胞菌(10.81%)。革兰阳性菌主要为凝固酶阴性葡萄球菌(12.84%)与金黄色葡萄球菌(7.43%)。真菌均为热带念珠菌。药敏结果显示,肺炎克雷伯菌对头孢呋辛、头孢他啶、头孢曲松、氨曲南、复方新诺明的耐药率高于40%,对亚胺培南、美罗培南的耐药率低于20%。大肠埃希菌对头孢呋辛、头孢他啶、头孢曲松、环丙沙星、左氧氟沙星、复方新诺明的耐药率高于50%,对亚胺培南、美罗培南的耐药率低于10%。铜绿假单胞菌对头孢他啶、环丙沙星、左氧氟沙星、莫西沙星的耐药率高于40%。肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌均未产生对阿米卡星的耐药株。凝固酶阴性葡萄球菌对氨苄西林、红霉素、环丙沙星、左氧氟沙星、复方新诺明的耐药率高于50%,金黄色葡萄球菌对氨苄西林、红霉素、环丙沙星的耐药率高于40%,均未产生对万古霉素、利奈唑胺的耐药菌。对比150例发生血流感染与60例未发生血流感染的血液病患者临�Objective To analyze the distribution characteristics and risk factors of pathogenic bacteria in patients with blood diseases complicated with blood flow infection.Methods 150 patients with blood diseases who had bloodstream infection in the Department of Hematology of the First Affiliated Hospital of Kunming Medical University from January 2021 to December 2021 were selected,and 60 patients without bloodstream infection in the same period were selected.The clinical data of all patients involved in this study,including age,type of disease,length of stay,neutrophil value,time of agranulocytosis,treatment methods,detection of pathogens and drug sensitivity test results were collected,and the risk factors of bloodstream infection in patients with blood diseases were analyzed.After bloodstream infection wass suspected to occur in patients with blood diseases,before the use of antibacterial drugs,peripheral venous blood of patients was drawn into blood culture bottles,and bacteria were cultured with automatic blood culture instrument,and pathogen identification and drug sensitivity test are conducted with automatic bacteria identification instrument.Results A total of 148 strains of pathogenic bacteria were detected in 150 patients with blood flow infection,including 93 strains of gram-negative bacteria,44 strains of gram-positive bacteria and 11 strains of fungi.Gram negative bacteria were mainly Klebsiella pneumoniae(21.62%),Escherichia coli(16.22%)and Pseudomonas aeruginosa(10.81%).Gram positive bacteria were mainly coagulase negative staphylococcus(12.84%)and Staphylococcus aureus(7.43%).The fungi were Candida tropicalis.The drug sensitivity results showed that the drug resistance rate of Klebsiella pneumoniae to cefuroxime,ceftazidime,ceftriaxone,aztreonam and cotrimoxazole was higher than 40%,while the drug resistance rate to imipenem and meropenem was lower than 20%.The resistance rate of E.coli to cefuroxime,ceftazidime,ceftriaxone,ciprofloxacin,levofloxacin and cotrimoxazole was higher than 50%,while the resi

关 键 词：血液病 血流感染 病原菌 危险因素 

分 类 号：R378[医药卫生—病原生物学]