恶性血液病患者肺部感染病原学及药敏分析

Analysis of drug sensitivity and etiology of pulmonary infection in patients with malignant blood disease

目的研究恶性血液病患者肺部感染时病原学分布及药敏情况。方法对135例血液恶性肿瘤住院患者的痰细菌培养及药敏试验结果进行回顾性分析。结果 135例恶性血液病患者痰标本分布为:革兰氏阴性菌66.2%,其中铜绿假单胞菌16.9%,嗜麦芽假单胞菌7.7%,肺炎克雷伯杆菌13.8%,鲍曼不动杆菌9.2%;革兰氏阳性菌18.5%,以金黄色葡萄球菌为主,占12.3%;真菌15.4%。药敏试验显示革兰氏阴性菌对广谱抗菌素产生耐药,中性粒细胞的下降与感染密切相关。结论临床上一方面应加强支持治疗,改善机体免疫力,缓解粒细胞缺乏,另一方面,应积极开展痰细菌培养和药敏试验,合理使用抗生素,减少耐药菌株的产生,可联合抗霉菌治疗。

Objective To analyze the drug sensitivity and etiology distribution of pulmonary infection in patients with malignant blood disease. Methods The data of sputum bacteria culture and the result of drug sensitivity test for 135 inpatients with blood malignant tumors were retrospectively analyzed. Results The distribution of sputum specimen of 135 patients with malignant blood disease was as follows. Gram negative bacterium was 66.2%, including Pseudomonas aeruginoea was 16.9%, Stenotrophomonas maltophilia was 7.7%, pneumonia Klebsiella was 13.8% , Acinetobacter baumannii was 9.2%. Gram positive bacterium was 18.5%, of which the main part was Staphylococcus aureus（ 12.3% ）. Fungi was 15.4%. The drug sensitivity test showed that Gram negative bacterium was resistant to broad spectrum antibiotics and the decrease of neutrophil was closely related to the infection. Conclusion On one hand, the clinical practice should strengthen supportive treatment, improve body immunity and relieve the deficiency of granulocytes ; on the other hand, the clinical practice should actively take sputum bacteria culture and drug sensitivity test, use antibiotics properly, decrease the production of drug-resistant strains and combine the antifungal treatment.