血液病患者医院感染的病原菌种类及耐药性

Species and antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with blood disease

目的探讨引起血液病患者发生医院感染的病原菌种类及耐药性现状,为临床医师控制医院感染选择抗菌药物提供理论依据。方法按照《全国临床检验操作规程》,无菌采集感染性标本进行细菌培养,采用法国生物梅里埃公司生产的VITEK-32全自动微生物分析仪和相应鉴定试剂盒进行菌种鉴定,参照CLSI推荐的K-B法进行药敏试验。结果分离的258株病原菌中,革兰阴性杆菌占69.8%;革兰阳性球菌占24.8%;真菌占5.4%;258株病原菌对临床常用的抗菌药物产生了严重的耐药性,革兰阴性杆菌耐药率>30.0%的抗菌药物有头孢噻肟、环丙沙星、左氧氟沙星、庆大霉素,铜绿假单胞菌和鲍氏不动杆菌对亚胺培南、美罗培南耐药率达到20.8%～25.0%;革兰阳性球菌耐药率>40.0%的抗菌药物有青霉素、红霉素、左氧氟沙星、环丙沙星;耐甲氧西林葡萄球菌检出率为63.2%～66.7%;但碳青霉烯类抗菌药物对肠杆菌科细菌、糖肽类抗菌药物对革兰阳性球菌仍然保持着100.0%的抗菌活性。结论血液病患者属于医院感染高危人群,其感染致病菌大多是耐药细菌;血液病房应采取针对性干预措施,预防与控制血液病患者医院感染的发生。

OBJECTIVE To approach the species and antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with blood disease and provide the evidence for clinical controlling of nosocomial infections and use of antibiotics.METHODS The infective specimen,by the aseptic technique,were collected to performed the bacterial culturation according to the National Guide to Clinical Laboratory Procedures.The VITEK 32 identification system（France,bioMérieux） and relative identification kits were used to identify the strains.Drug susceptibility testings were performed by K-B methods recommended by CLSI.RESULTS Among 258 strains of pathogens,gram-negative bacilli,gram-positive coccus and fungi accounted for 69.8%,24.8% and 5.4%,respectively.The susceptibility testing results indicated that 258 isolates were seriously resistant to the commonly used antibiotics.The antibiotics with above 30.0% of resistance rate against gram-negative bacilli included cefotaxime,ciprofloxacin,levofloxacin and gentamicin.The resistance rates of imipenim and meropenem against Pseudomonas aeruginosa and Acinetobacter baumannii arrived at 20.8%-25.0%.The antibiotics with above 40.0% of resistance rate against gram-positive cocci included penicilin,erythromycin,levofloxacin and ciprofloxacin.The detection rate of methicillin-resistant Staphylococci was 63.2%-66.7%.Carbapenem antibiotics against Enterobacteriaceae,glycopeptide antibiotics against gram-positive cocci remained 100.0% of the antibacterial activity.CONCLUSION The patients with blood disease are at high risk of infection in hospitals.The pathogenic bacteria are mostly resistant strains.The blood ward should take the targeted interventions to prevent and control the occurrence of nosocomial infections.