2005—2011年血液系统疾病院内感染流行病学及耐药性变迁

Epidemiology and antimicrobial resistance of clinical isolates about hospital infection from patients with hematological diseases

目的分析2005—2011年我科血液病住院患者院内感染的流行病学及其耐药性变迁。方法收集2005年1月至2011年12月住院血液病患者临床分离菌株1453株，采用微量稀释法进行药敏实验。结果①临床分离菌株中呼吸道标本最多为836株（57．5％）；血液标本比例占13．60％，高于全院（6．26％）；细菌培养送检阳性率52．37％，低于全院（60．24％）；化疗导致的粒细胞缺乏是院内感染的主要原因；革兰阳性菌578株（39．8％），革兰阴性菌875株（60．2％），革兰阳性菌中表皮葡萄球菌有上升趋势，革兰阴性菌特别是非发酵菌有上升趋势。②血液科耐甲氧西林金黄色葡萄球菌为72．8％、产ESBL大肠埃希菌为18．9％、产ESBL肺炎克雷伯菌为10．4％。@2005—2011年革兰阳性菌中葡萄球菌属和肠球菌属对抗生素的耐药性无明显变化；革兰阴性菌中肠杆菌科对碳青霉烯类保持高度敏感，其次为头孢哌酮／舒巴坦、哌拉西林／他唑巴坦，而大肠埃希菌对头孢吡肟和头孢他啶的耐药率逐年升高；不发酵糖革兰阴性菌中铜绿假单胞菌、鲍曼不动杆菌对头孢哌酮／舒巴坦保持敏感，其中铜绿假单胞菌对碳青霉烯类耐药率稍有上升趋势。结论血液病住院患者院内感染革兰阴性菌的比例有上升趋势，其中大肠杆菌比例最高；非发酵菌比例有上升趋势；大肠埃希菌对头孢吡肟和头孢他啶的耐药逐年升高，铜绿假单孢菌对碳青霉烯耐药率稍有上升趋势。

Objective To investigate the epidemiology and antibiotic resistance of isolates from hos- pitalized patients with hematological disease from 2005 to 2011. Methods A total of 1453 bacterial strains were isolated from patients with hematological disease from January 2005 to December 2011. Antimicrobial susceptibility testing was performed by micro-dilution method. Results （!）The majority of the bacterial strains were respiratory passage examples （57. 5% ）. The pertage of blood examples in our division （13.60%） was higher than of whole hospital （6. 26% ）, with lower positive rate of bacterial culture （52.37%） than of whole hospital （60.24%）. Chemotherapy-induced agranulocytosis was the main reason for hospital infection. 578 （39.8%）bacterial strains were gram positive, and 875 （60.2%）gram negative ba- cillus. Staphylococcus epidermidis strains and glucose nonfermenters had a tendency of ascensus. （~）Methicil- lin resistant staphylococcus aureus （MRSA） accounted for 72.8% antibiotic resistance. Detection rates of ESBLs in Escherichia eoli and Kleb-siella pneumoniae were 18.9% and 10.4%, respectively. （2）No obvious changes of antimicrobial resistances of Staphylococcus and Enterococcus were observed during these years. The Enterobaeteriaeeae strains showed lowest resistance rates to Carbopenems, next to Cefoperazone/sulbac- tam and Piperacillin/tazobactam. But the resistance rates of Escherichia coli to Cefepime and Ceftazidime were gradually increasing during the past years. Pseudomonas aeruginosa and Acinetobacter baumannii of glu- cose nonfermenters showed lowest resistance rates to Cefoperazone/sulbactam, but the resistance rate of Pseudomonas aeruginosa to Carbopenems increased. Conclusions Escherichia coli was the highest in quanti- ty of gram negative bacillus and glucose nonfermenters had a tendency of ascensus. The resistance rates of Escherichia coli to Cefepime and Ceftazidime, Pseudomones aeruginosa to Carbopenems were gradually in- creasing in the past years.