白血病患者院内获得性感染败血症的病原学分析

Analysis of etiology of septicemia in leukemia patients

目的探讨院内感染白血病患者并发败血症病原菌的分布及对抗生素的敏感性。方法对该院2004年1月～2008年12月从血液标本中分离的感染菌作回顾性分析。结果白血病患者血培养致病菌以G-杆菌多见,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌是最常见的致病菌,其次为G+球菌,主要为葡萄球菌属。G-杆菌对亚胺培南、头孢吡肟、哌拉西林/三唑巴坦、阿米卡星敏感,对青霉素类、单环β-内酰胺类以及头孢噻肟耐药率高,G+球菌对万古霉素敏感性较高,对其他抗生素大都耐药。结论超广谱β内酰胺酶以及耐甲氧西林葡萄球菌菌株增加导致白血病患者细菌耐药率增高,其主要原因是抗生素的滥用,细菌培养及药敏实验可指导临床抗生素的合理使用。

[Objective] To explore the drug sensitivity, characteristics and bacterium species distribution of blood cultures from leukemia patients with infectious septicemia. [Methods] The strains of pathogens, which were separated from blood samples in Jan. 2004, to Dec. 2008 in the First Affiliated Hospital of Henan University of Science and Technology, were retrospectively analyzed. [Results] G- bacteria were the most common causes of infections; E.coli, Klebsiella and Pseudomonas aeruginosa accounted for the most of G- bacterial infections, followed by G＋ coccus infections in which Staphylococci were the most common cause. G- bacteria were sensitive to Meropenem, Cefepime, Piperacillin/Tazobactam and Amikacin, resistant to Penicillin, Monobactams and Cefetaxime; G＋ Cocci were sensitive to Vancomycin, while resistant to most of other antibiotics. [Conclusion] Increased extended-spectrum β-lactamase and Methecillin-resistant Staphylococci are the major risks of drug resistance in leukemia patients with septicemia. Analysis on species distribution in blood cultures or the drug sensitivity may instruct the reasonable use of clinical antibiotics.