肿瘤患者医院感染病原菌分布与抗菌药物耐药分析

Distribution and antibacterial resistance study on nosocomial infection pathogens in tumor patients

目的调查肿瘤患者医院感染病原菌的分布及耐药趋势,为指导临床用药及控制医院感染提供依据。方法对2007年1月～2008年12月住院病人医院感染病原菌进行统计分析。结果共检出病原菌1482株,其中G-菌占59.99%,其次为真菌、革兰阳性菌,分别为22.87%,17.14%。G-菌以大肠埃希菌和肺炎克雷伯菌为主,产超广谱β-内酰胺酶(ESBLs)率分别为57.60%,20.60%,其中大肠埃希菌耐药较严重,仅对亚胺培南、厄它培南和哌拉西林/他唑巴坦、头孢替坦等抗菌药物敏感;G+菌以葡萄球菌属为主,其中耐甲氧西林株金黄色葡萄球菌和凝固酶阴性葡萄球菌分别占25.29%,89.66%,凝固酶阴性葡萄球菌的耐药性较严重,仅对万古霉素、利奈唑烷、喹努普汀/达福普汀敏感,对其他所测抗菌药物的耐药性均高于金黄色葡萄球菌;真菌以白色假丝酵母菌最多,占到致病菌的第2位。结论肿瘤患者医院感染病原菌的耐药问题日趋严重,重视和加强耐药菌医院感染管理,对指导临床合理应用抗菌药物,积极有效地控制医院感染具有重要意义。

Objective To investigate the pathogenic distribution and drug resistance of nosocomial infections and therefore to provide information for rational administration of antibiotics and control of nosocomial infections（NI）.Methods Pathogens of NI in tumor patients were analyzed from January 2007 to December 2008 in Fujian Provincial Hospital.Results 1 482 strains of pathogens had been isolated from NI infections,Gram-negative bacteria were the most pathogens isolated（59.99%）,followed by fungi（22.87%）and Gram-positive bacteria（17.14%）.Gram-negative bacteria was mainly Escherichia coli and Klebsiella pneumoniae（ESBL production rate：57.60% and 20.60% respectively）,in which Escherichia coli were worse for antibiotic resistance and only sensitive to a few antibiotics,including imipenem,piperacillin/tazobactam,cefotetan and so on.Gram-positive bacteria were mainly Staphylococcus（25.29%）.Coagulase negative ones（89.66%）were worse for antibiotic resistance and only sensitive to vancomycin,linezolid,quinoline Nupu Ting/Dafoe Putin and few other antibiotics.Candida albicans were the most common isolated species of fungi.Conclusion The fungi and drug resistance bacterial isolations were serious problems of NI,especially for tumor patients.It is critical to follow clinical guidance on antibiotic applications,strengthen effective measures for preventing occurrences of nosocomial infections.