老年血液肿瘤患者并发败血症病原菌及耐药性分析

Clinical analysis of old patients with neoplastic hematological disorder complicating septicemia

目的了解老年血液肿瘤并发败血症的病原菌分布及对抗生素的敏感性,指导临床治疗。方法回顾性分析48例老年血液肿瘤患者血培养标本中分离的病原菌及药敏实验资料。结果152份血培养标本检出致病菌48株,检出率31.6%,其中革兰阴性菌30株(62.5%)、革兰阳性菌16株(33.3%)、真菌2株(4.2%);除铜绿假单胞菌外,革兰阴性杆菌对亚胺培南、美洛培南的耐药率较低(<15%),对其他抗生素耐药性较高,三种主要革兰氏阴性菌大肠埃希氏菌、肺炎克雷伯菌、铜绿假单胞菌对氨苄西林几乎耐药(>90%);革兰阳性球菌对替考拉宁耐药率较低,对其他抗生素耐药性较高,未检出耐万古霉素菌株。结论老年血液肿瘤并发败血症病原菌以革兰阴性菌为主,抗生素的大量使用,使革兰阴性菌和阳性菌的耐药率都增高,应根据细菌培养及药敏实验对临床合理使用抗生素。

Objective To explore the drug sensitivity and bacterium species distribution of blood cultures from old patients with neoplastic hematological disorder complicating septicemia. Methods To retrospectively analyze the strains of pathogens separated from 48 blood samples and drug-sensitive data. Results Among the 48 strains of septicemia, G^-bacteria were the leading cause of infection （ 62.5% ） , followed by G ^＋ Coccus （ 33.3% ）. G^- bacteria were sensitive to imipenem and meropenem（ 〈 15% ） , resistant to other antibiotics. Three main G^- bacteria-Escherichia, Klebsiella, and Pseudomonas aeruginosa were all drug-resistant to ampicillin（ 〉 90% ）. G^＋ Coccus were all sensitive to vancomycin, most of them were sensitive to teicoolanin, while had resistance to other antibiotics. Conclusion Among old patients with neoplastic hematological disorder complicating septicemia, G^- bacteria are the leading cause of infection. Both G^- bacteria and G^＋ bacteria have a high drug-resist- ance rate as antibiotics are widely used now. Rational use of antibiotics is preferred based on bacterial culture and drug-sensitive assay.