血液病医院感染大肠埃希菌败血症临床和耐药分析

Survey on hospital infection of E.coli induced hematosepsis in patients with hematopathy

目的探讨血液病患者大肠埃希菌败血症特点及其耐药性。方法回顾性调查分析2000年至2005年住院血液病患者感染大肠埃希菌败血症的临床及细菌耐药性。结果3045例次住院血液病患者中,血液感染大肠埃希菌者38例,多数为恶性血液病,感染均发生在化疗、应用大剂量糖皮质激素和(或)广谱抗生素之后,除2例ITP外,中性粒细胞<0.5×109/L。大肠埃希菌对亚胺培南高度敏感,对氨苄西林、头孢唑林、磺胺药耐率达90%以上,对庆大霉素、环丙沙星、左氟氧沙星耐药率达80%以上,产ESBLs菌达58.8%。结论血液病患者感染大肠埃希菌败血症,是由免疫功能受到严重抑制,粒细胞缺乏,菌群失调引起,以内源性感染为主,故应提高机体的免疫功能,对粒细胞缺乏者应进行肠道除菌,治疗上可选用亚胺培南、哌拉西林/他唑巴坦、舒普深、头孢替坦等。

Objective To explore the clinical characteristics and drug-resistance of E. coli induced hematosepsis in patients with hematopathy. Methods Retrospective analyses of the clinical characteristics and drug of E. coli induced hospital infection of hematosepsis in patients with hematopathy treated from 2000 to 2005 were made. Results 38 of all the 3045 cases of hematopathy were infected with E. coli, and most of which were of malignant hematopathy. Most infections （ excluding a case of ITP） occurred after chemothepy or after applicaiton of large dosages of gluoacorticoid hormone and / or brood spect rum antibiotics. The volume of neutrophilic granulocyte was less than 0.5 × 10^9/L. E. coli responded extremely sensitively to imipenem. The rate of resistance to ampicillin, cefazoin and ulfonamides were over 90%. And the rate of resistance to entamycin, ciprofloxacin,levofloxacin were over 80%. The rate of reproduction of bacterial ESBLs was 58.8%. Conclusions The infections of E. coli hematosepsis, most of which were endogenous,mainly resulted from the severe prohibition of immune functions,lack of neutrophilic gradulocytes and flora imbalance. They should be treated by promoting immune functions, removing the pollution of intestinal tracts of cases lacking in gradulocytes, and unsing such drugs as imipenem, tobramycin, piperacillin/tazobactam, sulbactam sodium/cefoperazone sodium and cefotetan.