血液病患者革兰阳性菌感染病原菌构成及耐药性分析

Constitution and drug resistance of the gram-positive bacteria in hematologic disorders

目的探讨血液病患者革兰阳性菌感染发生率、病原菌构成及其耐药性,为临床抗菌药物的合理使用提供参考。方法对浙江大学医学院附属第一医院血液病患者临床标本进行细菌培养、细菌鉴定、药敏检测及耐药性分析。结果革兰阳性菌分离率由2007年19.9%上升到2011年32.9%。耐甲氧西林金黄色葡萄球菌(MRSA)与耐甲氧西林表皮葡萄球菌(MRSE)的检出率分别为61.4%、43.1%,MRSA、MRSE、肠球菌呈多重耐药,但未发现耐万古霉素菌株。结论近年来血液病患者革兰阳性菌感染呈上升趋势,且多重耐药现象严重,应根据药敏试验结果合理选用抗生素,谨慎使用万古霉素,以减少或避免新耐药菌株的出现。

Objective To investigate the infection rate,pathogen constitution and their drug resistance of hematologic disorders,and provide reference for rational use of antibiotics.Methods Specimens were obtained from the department of hematology of the First Affiliated Hospital of College of Medicine of Zhejiang University.Bacterial culture,drug-susceptibility test,and drug-resistance analysis were conducted based on these specimens.Results The rate of gram-positive bacteria in all isolated pathogens increased from 19.9% in 2007 to 32.9% in 2011.61.4% of the Staphylococcus aureus and 43.1% of the Staphylococcus epidermidis were detected as methicillin-resistant.MRSA,MRSE,and Enterococci were all multi-drug resistant.However,no vancomycin-resistant strain was found so far.Conclusion gram-positive infection in patients with hematologic disorders are on the rise in recent years,and multi-drug resistance is common.Susceptibility test should be made for rational use of antibiotics,and vancomycin should be used with great caution to reduce or avoid emergence of new resistant strains.