肿瘤病房常见病原菌分布及耐药性分析

Distribution of common pathogens in oncology ward and drug resistance

目的及时了解并动态掌握肿瘤病房病原菌分布及耐药趋势,指导临床合理使用抗菌药物。方法回顾性统计分析2009-2010年肿瘤住院患者分离的病原菌菌种和耐药性。结果 2625例肿瘤患者培养标本中,共分离出1210株病原菌,阳性率为46.1%,其中革兰阴性菌743株占61.4%,主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌,革兰阳性菌312株占25.8%,主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌,真菌155株,占12.8%;产ESBLs大肠埃希菌、肺炎克雷伯菌检出165、44株,检出率为55.7%、47.8%;肠杆菌科细菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦及头孢哌酮/舒巴坦等酶抑制复合剂的敏感性较好;未分离出耐碳青霉烯酶的大肠埃希菌、肺炎克雷伯菌;耐甲氧西林金黄色葡萄球菌分离出51株,分离率为52.0%;葡萄球菌属对多数抗菌药物耐药率较高,未出现耐万古霉素菌株,肠球菌属耐药严重,屎肠球菌耐药率高于粪肠球菌,真菌对两性霉素B、伏立康唑的耐药性较低。结论肿瘤病区病原菌耐药性严重,医院应重视病原学及耐药性检测,对控制医院感染及临床合理应用抗菌药物有指导意义。

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in oncology ward so as to provide reliable evidence for clinical use of antibacterial drugs.METHODS The species and the drug resistance of the pathogens isolated from hospitalized tumor patients during 2009-2010 were retrospectively analyzed.RESULTS Of the specimens obtained from 2625 tumor patients,totally 1210 strains of pathogens were isolated with the positive rate of 46.1%,there were 743（61.4%） strains of gram-negative bacteria,including Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae,there were 312（25.8%） strains of gram-positive bacteria,among which Staphylococcus aureus,coagulase-negative Staphylocci and Enterococcus faecalis were dominant,and there were 155（12.8%） strains of fungi;there were 165 strains of ESBLs-producing E.coli and 44 strains of ESBLs-producing K.pneumoniae isolated,the detection rates were 55.7% and 47.8%,respectively.Enterobacteriaceae were highly susceptible to imipenem,meropenem,and enzyme inhibition compound agents such as piperacillin/tazobactam,cefoperazone/sulbactam;there were no carbapenems-resistant E.coli or K.pneumoniae strains detected;there were 51 strains of MRSA with the detection rate of 52.0%;the resistance rates of Staphylococci were high to most of antibacterial drugs,there were no strains resistant to vancomycin,the drug resistance of Enterococci was severe,the drug resistance rate of E.faecium was higher than that of E.faecalis,the fungi showed low drug resistance to amphotericin B and voriconazole.CONCLUSION The hospital should focus on the detection of etiology and drug resistance,which has great significance in guiding the control of nosocomial infections and reasonable use of antibiotics.