血液系统疾病医院感染临床分离菌株分布与耐药性分析

Clinical Isolates Caused Hospital Infection in Patients with Hematological Diseases:Their Distribution and Antimicrobial Resistance

目的分析血液病住院患者医院感染临床分离菌的分布及其耐药现状。方法收集2005年1月-2007年12月住院血液病患者临床分离菌株,采用微量稀释法进行药敏试验。结果共检出病原菌431株,革兰阳性菌170株(39.5%),革兰阴性菌194株(45.0%),真菌67株(15.5%);革兰阳性菌中屎肠球菌占6.3%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为71.4%和35.8%,未检出对耐万古霉素葡萄球菌和肠球菌;血液科最常见革兰阴性菌中依次为大肠埃希菌14.6%、肺炎克雷伯菌7.7%、铜绿假单胞菌5.6%、嗜麦芽寡养单胞菌5.1%、鲍氏不动杆菌4.9%;大肠埃希菌和肺炎克雷伯菌ESBLs的检出率分别为17.5%和9.1%;2007年检出泛耐药铜绿假单胞菌2株。结论血液病患者合并医院感染病原菌以革兰阴性菌为主,应合理使用抗菌药物,防止多药耐药株与泛耐药菌株的出现,降低医院感染发生率。

OBJECTIVE To investigate the distribution and antibiotic resistance of isolates from hospitalized patients with hematological disease iu 2005-2007. METHODS A total of 431 bacterial strains were isolated from patients with hematological disease from Jan 2005 to Dec 2007. Antimicrobial susceptibility testing was taken by microdilution method. RESULTS Among the 364 bacterial strains, 170 （39.5.7%） were Gram-positive organisms and 194 （45.0%） were Gram-negatives. Among the 170 Gram-positive strains, 41.2% were enterococci and 6.3% were E. faecium strains, meticillin-resistant Staphylococcus aureus （MRSA） and meticillin-resistant coagulase negative staphylococcus （MRCNS） accounted for 71.4% and 35.8%. No vancomycin resistant Staphylococcus spp and Enterococcus spp were found. The top 5 Gram-negtive species were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophornonas maltophilia and Acinetobacter baumannii. Detection rates of ESBLs in E. coli and K. pneumoniae were 17. 5% and 9. 1%. Two pan-resistant P. aeruginosa strains were found in 2007. CONCLUSIONS Our data are important and valuable for the rational antimicrobial therapy of infections in patients with hematolagical disease.