肿瘤患者血培养病原菌分布及耐药性研究

Distribution of Pathogenic Bacteria in Blood Culture from Cancer Patients and Drug Resistance

目的了解河南省肿瘤医院肿瘤患者血培养的病原菌分布和耐药性,为临床合理用药提供依据。方法对医院2006年1月-2009年10月送检的血液或骨髓标本按常规方法进行分离、菌种鉴定和药敏试验。结果 4年血培养中革兰阴性菌,检出率分别为53.8%、46.9%、40.0%、53.3%,革兰阳性菌检出率分别为26.5%、35.0%、30.0%、23.7%,真菌检出率分别为19.7%、18.1%、30.0%、23.0%;最常见的病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、肺炎克雷伯菌、皱褶假丝酵母菌、近平滑假丝酵母菌;连续4年大肠埃希菌及肺炎克雷伯菌对亚胺培南、美罗培南敏感率100.0%;凝固酶阴性葡萄球菌及金黄色葡萄球菌对万古霉素和替考拉宁敏感率100.0%,均未发现耐药株。结论 2006-2009年医院肿瘤患者血液感染以革兰阴性菌尤其以大肠埃希菌为主,且具有多药耐药性,血培养分离菌中真菌所占比例增多明显,所以及时监测病原菌变化及耐药趋势,对指导临床用药至关重要。

OBJECTIVE To analyze the distribution and the drug resistance of pathogenic bacteria in blood culture for cancer patients in Henan Tumor Hospital to provide bases for clinically rational drug use.METHODS The pathogens from blood or the bone marrow samples collected from Jan 2006 to Oct 2009 in our hospital were isolated by conventional methods,strain identification and drug susceptibility test.RESULTS The detection rates of Gram-negative bacteria were 53.8%,46.9%,40.0% and 53.3%,while the detection rates of Gram-positive bacteria were 26.4%,35.0%,30.0% and 23.7%,the detection rates of fungi were 19.8%,18.1%,30.0% and 23.0% within 4 consecutive years.The most common strains were Escherichia coli,coagulase-negative staphylococci （CNS）,Staphylococcus aureus,Klebsiella pneumoniae,Candida rugosa and C.parapsilosis in turn,the susceptibility rates of E.coli and Klebsiella strains to imipenem and meropenem were 100% within 4 consecutive years,the susceptibility rates of CNS and S.aureus to vancomycin and teicoplanin were 100%,without finding any drug-resistant strains.CONCLUSION Gram-negative bacteria are the major ones to cause blood infection,among which E.coli with multiple drug resistance is the most common,and the proportion of isolated fungi increases significantly.Therefore,it is important to monitor the changes and the drug resistance trends of pathogens in time in guiding the clinical use of drugs.