血液病房病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from hematology department

目的调查血液内科病原菌的分布及耐药趋势,以指导临床合理使用抗菌药物。方法对2009年1月-2010年11月血液内科住院患者送检的2707份各类标本中分离出的病原菌及药敏结果进行回顾性分析。结果共分离出病原菌205株,其中革兰阳性菌50株占24.39%,以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主;革兰阴性菌117株占50.07%,以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主;真菌38株占18.54%,其中以白色假丝酵母菌和近平滑假丝酵母菌为主;主要标本来源为血液,占83.71%,其次为痰占6.54%;葡萄球菌属中耐甲氧西林菌的检出率高达86.20%,革兰阴性菌株中产ESBLs的阳性率为35.90%;革兰阴性杆菌对碳青霉烯类以及含有酶抑制剂的药物耐药率较低,大肠埃希菌耐药率均较高,而铜绿假单胞菌和肺炎克雷伯菌的耐药率不高。结论血液病患者最易发生血源性感染,以革兰阴性菌为主,真菌的感染率较高,对疑似合并感染的患者应及时留取标本进行微生物鉴定,并依据药敏试验调整用药,以便有效的控制感染和防止耐药性的产生。

OBJECTIVE To investigate the clinical distribution characteristics and drug resistance of pathogens in hematology department during the recent two years,and to instruct reasonable clinical application of antibiotics.METHODS The distribution,category and drug resistance of pathogenic bacteria isolated from 2707 specimens of patients in hematology department from Jan.2009 to Nov.2010 were retrospectively analyzed.RESULTS A total of 205 strains of pathogens were isolated.The component ratio of gram-positive bacteria,gram-negative bacteria and fungi were 24.39%,50.07% and 18.54%,respectively.The most common gram-negative bacteria were Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumonia;and the dominant gram-positive pathogenic bacteria were coagulase-negative Staphylococcus and Staphylococcus aureus;and the major fungi were Candida albicans and Candida parapsilosis.The dominant source of pathogens was blood（83.71%）,followed by sputum（6.54%）.Cefoxitin resistance was identified in 86.2% of Staphylococcus.No Staphylococcus strain resistant to vancomycin,linezolid and minocycline was detected.The extended spectrum β-lactamases（ESBLs） producing strains in gram-negative pathogenic bacteria were 35.90%.The drug resistant rates of the gram-negative bacilli to carbapenem and drugs containing enzyme inhibitor were low.The drug resistant rates of E.coli to current antibiotics were very high,but the drug resistant rates of P.aeruginosa,and K.pneumonia were low.CONCLUSION The most common site of infection is blood stream and the dominant pathogen is gram-negative bacteria in hematology department,and the infection rate of fungi is quite higher.Timely collection of specimens,better microbiological identification and appropriate susceptibility testing are essential for effective infection control and prevention of antibiotic resistance