恶性肿瘤患者医院感染病原菌的耐药特点

Drug resistance of pathogens causing nosocomial infections in patients with malignant tumor

目的探讨恶性肿瘤患者医院感染病原菌对抗菌药物的耐药特点,为临床预防与控制医院感染提供参考依据。方法按照《全国临床检验操作规程》,无菌采集感染标本进行细菌分离培养,采用常规方法进行菌种鉴定,参照CLSI推荐的K-B法进行药敏试验。结果从288例患者的感染性标本中分离出325株病原菌,其中革兰阳性球菌78株占24.0%,革兰阴性杆菌211株占64.9%,真菌36株占11.1%;革兰阴性杆菌耐药率<20.0%的抗菌药物为阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦等;耐药率>35.0%的抗菌药物有氨苄西林、头孢噻肟、环丙沙星、磺胺甲噁唑/甲氧苄啶、庆大霉素;泛耐药铜绿假单胞菌和鲍氏不动杆菌分别占18.0%、20.0%;革兰阳性球菌对糖肽类抗菌药物和利奈唑胺100.0%敏感,但耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分别占54.2%、55.0%。结论恶性肿瘤患者医院感染病原菌种类繁多,耐药性严重,其感染诱发因素复杂,感染预后不良,因此应提高防范意识,采取针对性干预策略,预防与控制医院感染暴发流行。

OBJECTIVE To approach the drug resistance of pathogenic bacteria causing nosocomial infections in patients with malignant tumors so as to provide evdenle to the clinical prevention and control of nosocomial infections.METHODS According to National Guide to Clinical Laboratory Procedures,the infective specimen were collected aseptically for bacterial cultivation and identification by the routine methods.The drug susceptibility testings were performed by K-B methods recommended by CLSI.RESULTS A total of 325 strains of pathogenic bacteria were isolated from 288 cases of infective specimen,including 78（24.0%） strains of gram-positive cocci,211（64.9%） strains of gram-negative bacilli and 36（11.1%） strains of fungi.The drug susceptibility testing indicated that the antibiotics with the resistance rate below 20.0% included amikacin,imipenem,meropenem,and cefoperazone/sulbactam,and those with resistance rate above 35.0% consisted of ampicillin,cefotaxime,ciprofloxacin,trimethoprim-sulfamethoxazole and gentamicin.The pan-resistant Pseudomonas aeruginosa and Acinetobacter baumannii accounted for 18.0% and 20.0%,respectively.100% of the gram-positive cocci were sensitive to glycopeptide antibiotics and linezolid.Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococci accounted for 54.2% and 55.0%,respectively.CONCLUSION There are various species of pathogens causing nosocomial infections in the patients with malignant tumors,the drug resistance is severe,the predisposing factors for the infections are complex,there is poor prognosis of the infections,thus it is necessary to adopt the targeted interventions in response to the prevention and control of the outbreak and prevalence of nosocomial infections.