造血干细胞移植患者肠道和口咽部定植菌与血流感染病原菌分布及其耐药性  

Distribution and drug resistance of intestinal and oropharyngeal colonization of bacteria and pathogens causing bloodstream infection in hematopoietic stem cell transplantation patients

作　　者：宋晓超 金美娟[1] 丁蔚[1] 王毛俊 SONG Xiao-chao;JIN Mei-juan;DING Wei;WANG Mao-jun(The First Affiliated Hospital of Suzhou University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院感染管理处,江苏苏州215006 [2]苏州大学附属第一医院医务处,江苏苏州215006

出　　处：《中华医院感染学杂志》2024年第18期2745-2751,共7页Chinese Journal of Nosocomiology

基　　金：江苏省医院协会医院管理创新研究面上指导项目(JSYGY-3-2023-103、JSYGY-3-2023-114);苏州市医院协会感染管理专项重点项目(SZSYYXH-2023-ZD1)。

摘　　要：目的探讨造血干细胞移植(HSCT)患者口咽部和肠道定植菌与血流感染病原菌分布及其耐药性,为临床合理用药治疗提供数据支持。方法回顾性调查2018年1月-2023年12月血液净化病房患者的临床资料、主动筛查和血培养微生物信息,分析其病原菌分布及耐药性特点。结果3686例HSCT患者发生血流感染256例次(6.95%),血流感染病原菌以革兰阴性菌(81.25%)为主,主要为肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌;与主动筛查革兰阴性定植菌分布较为一致;血流感染组中,肺炎克雷伯菌和阴沟肠杆菌对碳青霉烯类和替加环素等耐药率高于口咽拭子组(P<0.05),铜绿假单胞菌仅对氨曲南的耐药率较高,嗜麦芽寡养单胞菌仅对米诺环素的耐药率较高;血流感染组与直肠拭子组耐碳青霉烯肺炎克雷伯菌(CRKP)检出率和构成比均较高,两组药敏结果多无统计学差异;口咽拭子组CRKP检出率和构成比较高,对阿米卡星的耐药率高于血流感染组(P<0.05);直肠拭子组和口咽拭子组碳青霉烯耐药肠杆菌科细菌(CRE)定植继发血流感染率分别为15.45%和18.52%。其中,口咽拭子组CRKP定植继发血流感染率为31.25%,直肠拭子CRKP、耐碳青霉烯大肠埃希菌(CREC)和耐碳青霉烯阴沟肠杆菌(CRECL)定植继发血流感染率分别为18.03%、11.11%和15.38%,耐药谱高度相似。CRKP对阿米卡星、磷霉素和多黏菌素B的耐药率为0.00%~33.33%,对替加环素的耐药率高达40.98%~56.25%。结论应重点主动筛查HSCT患者肠道CRE定植菌和口咽部CRKP定植菌,疑似血流感染及时结合其耐药特点指导感染防控。OBJECTIVE To explore distribution and drug resistance of intestinal and oropharyngeal colonization of bacteria and pathogens causing bloodstream infection in hematopoietic stem cell transplantation patients so as to provide data for reasonable clinical use of antibiotics.METHODS The clinical data,active screening information and blood culture information were collected from the patients of blood purification wards from Jan 2018 to Dec 2023 and were retrospectively investigated.The distribution and drug resistance of the isolated pathogens were observed.RESULTS Among the 3686 HSCT patients,256 case-times(6.95%)of patients had bloodstream infection.Gram-negative bacteria(81.25%)were dominant among the pathogens causing the bloodstream infection;Klebsiella pneumoniae,Escherichia coli and Enterobacter cloacae were the predominant species of the gram-negative bacteria,showing the same distribution with the active screening of colonized gram-negative bacteria.The drug resistance rates of K.pneumoniae and E.cloacae strains to carbapenems and tigecycline were higher in the bloodstream infection group than in the oropharyngeal swab group(P<0.05);the drug resistance rate of the Pseudomonas aeruginosa strains to aztreonam was high,and the drug resistance rate of the Stenotrophomonas maltophilia strains to minocycline was high.Both the isolation rate and constituent ratio of the carbapenem-resistant K.pneumoniae(CRKP)strains were high in the bloodstream infection group and the rectal swab group,and there was no significant difference in the result of drug susceptibility testing.The isolation rate and constituent ratio of the CRKP strains were high in the oropharyngeal swab group,and the drug resistance rate to amikacin was higher in the oropharyngeal swab group than in the bloodstream infection group(P<0.05).The incidence rate of secondary bloodstream infection caused by colonization of carbapenem-resistant Enterobacteriaceae(CRE)was 15.45%in the rectal swab group,18.52%in the oropharyngeal swab group;the incidence rate of s

关 键 词：造血干细胞移植 血流感染 定植菌 病原菌 碳青霉烯耐药肠杆菌科细菌 耐药性 

分 类 号：R552[医药卫生—血液循环系统疾病]