血液病患者血流感染的病原菌和耐药性分析

Pathogenic bacteria and its drug resistance of blood flow infection in patients with hematological disease

目的了解安徽医科大学第一附属医院血液病患者血培养的病原菌分布和耐药性情况,为临床合理用药提供依据。方法对我院2007年1月至2009年3月血液内科送检的血液或骨髓标本,使用BACTEC-9120血培养仪培养,用MicroScanWalk Away-40微生物鉴定系统进行菌种鉴定和药敏试验。结果在1012份血液病患者的血培养标本中,共检出病原菌117株,阳性率11.6%,117株病原菌中革兰阴性菌51株(43.6%),革兰阳性菌50株(42.7%),真菌16株(13.7%),最常见的菌种依次是:大肠埃希氏菌28株(23.9%),人葡萄球菌人亚种25株(21.4%),表皮葡萄球菌10株(8.5%),肺炎克雷伯氏菌10株(8.5%),近平滑念珠菌6株(5.1%),大肠埃希氏菌和肺炎克雷伯氏菌产超广谱β-内酰胺酶(ESBLs)阳性率分别是75%和30%,耐甲氧西林凝固酶阴性的葡萄球菌(MRCNs)阳性率85.7%,病原菌出现很高的多重耐药性,对革兰阳性球菌和革兰阴性杆菌最敏感的药物是万古霉素和亚胺培南。结论本分析结果显示,我院血液科患者血流感染以大肠埃希氏菌和CNS为主,具有多重耐药性,提示临床医师应加强对血液病患者血培养的检测和合理使用药物。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in blood culture of patients with hematological disease in our hospital in order to provide references for clinical antimicrobial drug usage reasonably. Methods Blood or marrow samples from blood department in our hospital from January 2007 to march 2009 were cultured with BACTEC-9120 instrument and Micro Scan Walk Away- 40 system was used to detect the bacteria and drug sensitivity tests. Results The 117 strains of pathogens were isolated from 1012 samples of blood culture from patients with hematological disease,whose positive rate was 11.6% ,51 strains（43.6% ） gram - negative microbes and 50 strains（42.7% ） gram - positive microbes and 16 strain（ 13.7% ） fungi were among 117 strains. Pathogenic bacteria,the most commonly microbial strains were in turn Escherichia coli 28 cases（23.9% ）, S. homonis -homin 25 cases（21.4% ）, S. epidermidis 10 cases（8.5% ）, K I. pneu- moniae 10 cases（8.5% ）, C parapsilosis 6 cases（5.1% ）. The positive rates of ESBLs in Escheriehia coli and in K I. pneumoniae were respectively 75% and 30% , the positive rate of meticillin - resistant coagulase negative staphylococcus （MRCNS） was 85.7%. And the pathogens showed highly multiple drug resistance, vancomycin and imipenem were respectively the highest sus- ceptible for Gram - positive cocci and Gram - negative bacilli. Conclusions This analysis results showed that patient＇s blood flow from blood department in our hospitol were mainly infected by the Escherichia coli and CNS, they had the multiple drug resistance, all these prompted that clinicians shoud strengthen detection of blood cuhrue and rational use of antibiotic in patients with hematological disease .