恶性肿瘤及血液病患者血流感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing blood stream infections in patients with malignant tumor and blood disease

目的研究恶性肿瘤及血液病患者血流感染的病原菌分布及耐药性,为临床早期诊断和正确使用抗菌药物治疗提供依据。方法采用BacT/Alert 3D全自动血培养仪进行血培养,用VITEK-2微生物分析仪进行微生物鉴定和药敏试验,对2009-2011年的5173例恶性肿瘤及血液病住院患者的血培养及药敏结果进行回顾性分析。结果从5173份血培养标本中分离病原菌568株,其中革兰阴性菌388株占68.3%,以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主,革兰阳性菌159株占28.0%,以屎肠球菌、金黄色葡萄球菌和表皮葡萄球菌为主,真菌21株占3.7%,以热带假丝酵母菌为主;大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南的敏感率均为100.0%,铜绿假单胞菌对阿米卡星及哌拉西林/他唑巴坦敏感率高;葡萄球菌属对万古霉素、利奈唑胺的敏感率均为100.0%,屎肠球菌对利奈唑胺、喹奴普汀/达福普汀敏感率均>95.0%。结论血培养检出的病原菌种类多、耐药率高、危害程度大;血液病及恶性肿瘤患者免疫功能低下、抵抗力差;因此,及时进行病原菌及耐药性监测、正确选用抗菌药物、及早控制血流感染,对预后非常重要。

OBJECTIVE To study the distribution and drug resistance of pathogenic bacteria causing blood stream infections in patients with malignant tumour and leukemia,so as to provide evidences for the early diagnosis and effective treatment of the infectious diseases.METHODS The blood samples were cultured with BacT/Alert 3D system,the microorganisms were identified and the drug susceptibility testing was performed by VITEK-2 automatic microbiological analysis system.RESULTS Totally 568 strains of pathogens were isolated from 5173 clinical blood specimens,among which there were 388（68.3%） strains of gram-negative bacteria,159（28.0%） strains of gram-positive bacteria,and 21（3.7%） strain of fungi;Escherichia coli,Klebsiella pneumonia,and Pseudomonas aeruginosa were the predominant gram-negative bacteria;Enterococcus faecium and Staphylococcus aureus and S.epidermidis were the main species of gram-positive bacteria;Candida tropiclis was the main species of fungi;the drug susceptibility testing showed that the drug susceptibility rates of E.coli and K.pneumoniae to imipenem and meropenem were all 100.0%,the drug susceptibility rates of P.aeruginosa to amikacin and piperacillin/tazobactam were relatively high,the drug susceptibility rates of Stapylococci to both vancomycin and linezolid were 100.0%,and the drug susceptibility rates of E.faecium to linezolid and quinupristin/dafopristin were higher than 95.0%.CONCLUSION The pathogens isolated from the blood culture specimens are widely distributed and highly drug resistant and can cause severe harmness;as the patients with blood disease and malignant tumor have the low immunity,thus it is necessary to monior the pathogens and the drug resistance,reasonably use antibiotics,and control the blood stream infections in a timely manner,which is extraordinarily important forthe prognosis.