2007-2010年肿瘤患者感染的病原菌分布及耐药性分析

Distribution of pathogens in tumor patients with infection and their antibiotic resistance

目的了解2007-2010年南京医科大学第一附属医院血液科及肿瘤科肿瘤患者感染病原菌分布及耐药性规律,指导临床用药。方法采用API鉴定系统鉴定细菌及真菌,纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌对抗真菌药物敏感性;WHONET5.5软件进行统计分析。结果 2007-2010年血液科及肿瘤科肿瘤患者感染后共分离病原菌379株和237株;血液科肿瘤患者感染前3位病原菌依次为大肠埃希菌、表皮葡萄球菌、肺炎克雷伯菌,检出率分别为13.5%、11.9%、11.1%;肿瘤科肿瘤患者感染前3位病原菌依次为大肠埃希菌、肺炎克雷伯菌、白色假丝酵母菌,检出率分别为19.4%、10.5%、9.7%;未发现耐万古霉素葡萄球菌,但对其他多种抗菌药物耐药;肠杆菌科细菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦和哌拉西林/他唑巴坦较敏感;非发酵菌对环丙沙星和头孢哌酮/舒巴坦较敏感,但对其他抗菌药物耐药性较高。结论血液科及肿瘤科肿瘤患者感染病原菌对多种抗菌药物耐药性较高,应引起重视,加强抗菌药物合理使用。

OBJECTIVE To determine the distribution of pathogens in tumor patients with infection among hematology and oncology departments and their antibiotic resistance from the first Affiliated Hospital of Nanjing Medical University from 2007 to 2010. METHODS API detection system was used to identify bacteria and fungi. Disk diffusion susceptibility test was used to determine the antimicrobial susceptibility, Rosco disk diffusion method was used to determine the antifungal susceptibility, and results were analyzed by Rosco standardization. All data were analyzed by WHONET 5. 5 software. RESULTS A total of 379 and 237 pathogens were isolated from cancer patients of hematology and oncology departments from 2007 and 2010 respectively. The top three pathogens isolated from cancer patients of hematology department were Escherichia coli （13.5 %）, Staphylococ- cus epidermidis （11. 9%） and Klebsiella pneumoniae （11. 1%）, the top three pathogens from Oncology department were E. coli （19.4 %）, Klebsiella pneumoniae （10.5 %） and Candida albicans （9.7 %）. Resistance analysis showed Staphylococcus to vancomycin was not found in both two departments, but Staphylococcus strains were found resistant to many other antimicrobial agents. Enterobacteriaceae strains were found more sensitive to imipenem, meropenem, cefoperazone/sulbactam and piperacillin/tazobactam compared with other antimicrobial agents. Non-fermenting bacteria were found sensitive to ciprofloxacin and cefoperazone/sulbactam while highly resistant to other antimicrobial agents. CONCLUSION Relatively high resistance to variety of antimicrobial agents is found in cancer patients from hematology and oncology departments, which should be paid more attention tostrengthen the rational use of antimicrobial agents.