2016-2021年儿童血液病房血流感染病原菌分布及耐药性分析  

The distribution and drug resistance ofpathogens of bloodstream infection in pediatric hematology depart⁃ment in 2016⁃2021

作　　者：胡海玉[1] 张坤龙[1] 储金华[1] 王宁玲[1] 程雁[1] HU Haiyu;ZHANG Kunlong;CHU Jinhua;WANG Ningling;CHENG Yan(Department of Pediatric,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院儿科,合肥230601

出　　处：《实用医学杂志》2023年第8期991-996,共6页The Journal of Practical Medicine

基　　金：安徽省卫生健康科研项目(编号:AHWJ2022c006);白求恩·医学科学研究基金(编号:SCE128EN);安徽医科大学校科研基金(编号:2021xkj168)。

摘　　要：目的 探讨分析儿童血液病房血流感染(BSI)的病原菌分布及耐药情况,为临床医生选择抗菌药物提供依据。方法 回顾性分析安徽医科大学第二附属医院2016年1月至2021年12月儿童血液病房发生BSI患者的临床资料、病原学特征及耐药情况等。结果 发生BSI患者145例,共分离出菌种155株,其中革兰阴性菌92株(59.3%),革兰阳性菌59株(38.1%)。前四位分别为凝固酶阴性葡萄球菌(20%),肺炎克雷伯菌(16.1%)、大肠埃希菌(13.5%)和铜绿假单胞菌(9.7%)。铜绿假单胞菌有逐渐增加的趋势。急性髓系白血病(AML)比急性淋巴细胞白血病(ALL)患者更易合并革兰阳性菌感染。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶菌株(ESBLs)检出率分别为66.7%和40.0%。肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗菌药物敏感率为88.0%和100.0%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为26.6%和13.3%。甲氧西林耐药的凝固酶阴性葡萄球菌(MRCNS)和金黄色葡萄球(MRSA)检出率分别为81.1%和32.4%。葡萄球菌属无对万古霉素和利奈唑胺耐药菌株。结论 儿童血液病房BSI以革兰阴性菌为主;与ALL患者相比,AML患者更易合并革兰阳性菌感染。应根据不同的病种、各地区的病原菌分布和耐药情况合理选择经验性抗菌药物。Objective To analyze the distribution and drug resistance of pathogenic bacteria in blood⁃stream infection inpediatric hematology department,providing references of clinical empirical medication.Methods In this study,we retrospectively analyzed the BSI in children with hematological diseases from 2016 to 2021 at the second hospital of Anhui Medical University,including an assessment of the clinical characteristics,distribution of pathogens,and antibiotic resistance data.Results There were 145 patients with BSI,155 strains of pathogenic were isolated from the patients,including 92 strains(59.3%)of gram⁃negative bacteria and 59strains(38.1%)of gram⁃positive bacteria.The top four proportion of pathogenic bacteria were coagulase⁃negative staphylococcus(20%),Klebsiella pneumonia(16.1%),Escherichia Coli(13.5%),and Pseudomonas aeruginosa(9.7%).Thepro⁃portion of Pseudomonas aeruginosa increased gradually.The patients of acute myeloid leukemia(AML)were more likely to be infected with gram⁃positive bacteriathan than acute lymphoblastic leukemia(ALL).There were 66.7% and 40.0% Klebsiella pneumonia and Escherichia Coli with extended⁃spectrum β⁃lactamase⁃producing respectively.Susceptibility rates of Klebsiella pneumonia and Escherichia Coli to carbapenems were 88.0%and 100.0%.Resis⁃tance rates of Pseudomonas aeruginosa to imipenem and meropenem were 26.6% and 13.3% respectively.Detection rate of Methicillin⁃resistant coagulase⁃negative staphylococci(MRCNS)and Methicillin⁃resistant staphylococcus aureus(MRSA)were 81.1% and 32.4% respectively.No bacteria with vancomycin⁃resistant and linezolid⁃resistant were found in staphylococcus.Conclusions The main pathogenic bacteriaof BSI hospitalized in the pediatric hema⁃tology department is gram⁃negative bacteria,proportion of some species has increasing tendency.The patients of AML are more likely to be infected with gram⁃positive bacteria than the patients of ALL.Antibiotics should be selected rationally based on the diseases,distribution of path

关 键 词：儿童 血液病 血流感染 病原菌 耐药性 

分 类 号：R725.5[医药卫生—儿科]