血液病患者临床分离病原菌分布及耐药性特点

Distribution and antimicrobial resistance of pathogens isolated from clinical specimens in patients with hematological diseases

目的：分析从血液病住院患者中分离的细菌的分布情况及其耐药现状。方法：收集我院血液科2009年1月至2011年12月合并感染住院患者的临床分离细菌菌株．用Kirby-Bauer法进行药敏试验．并应用WHONET5．5软件分析数据。结果：2009年至2011年从血液科临床标本中共分离出583株细菌．其中革兰阴性杆菌317株（54．4％）、革兰阳性球菌266株（45．6％）。居前5位的细菌分别为，大肠埃希菌、肺炎克雷伯杆菌、屎肠球菌、鲍曼不动杆菌和粪肠球菌。肠杆菌科细菌（大肠埃希菌、肺炎克雷伯菌）对碳青霉烯类抗生素高度敏感（90．3％～100％）：而部分鲍曼不动杆菌对碳青霉烯类抗生素出现耐药．其对亚胺培南及美罗培南的耐药率为22．2％。未发现对万古霉素、替考拉宁耐药的革兰阳性球菌菌株：肠球菌属细菌中屎肠球菌对所测试的各类抗菌药物的耐药率均高于粪肠球菌。大肠埃希菌、肺炎克雷伯菌中产超广谱B-内酰胺酶（ESBLs）株分别占64．4％、36．9％；金黄色葡萄球菌和凝固酶阴性葡萄球菌甲氧西林耐药株的检出率分别为53．2％、81.2％。结论：本院血液病房细菌耐药性呈增长趋势．应进行流行病学调查并采取有效的控制措施．临床上应根据血液科细菌分布的特点．有针对性地合理应用抗生素。

Objective To analyze the distribution and antimicrobial resistance of pathogens isolated from hospitalized patients with hematological diseases. Methods Bacterial strains were isolated from patients with hematological disease from January 2009 to December 2011. Antimicrobial susceptibility testing was performed by Kirby- Bauer method and the data was analyzed by WHONET 5.5 software. Results During 2009-2011, a total of 583 pathogens were isolated, including 317 （54.4%） strains of gram-negative bacilli and 266 （45.6%） strains of gram-positive bacilli. The first 5 strains of microbes in frequency order were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Acinetobacter baumannii and Enterococcus faecalis. The Enterobacteriaceae strains （Escherichia coli, Klebsiella pneumoniae） were still highly susceptible to carbapenems, the sensitivity rate was 90.3%-100%. About 22.2% of Acinetobacter baumannii strains were resistant to imipenem and meropenem. As for the gram-positive cocci, no strain was found resistant to vancomycin and teicoplanin. In Enterococcus spp., the resistance rates of Enterococcus faecium strains to the tested drugs were higher than those of Enterococcus faecalis. The rates of extended spectrum beta- lactamase （ESBLs） producing Escherichia coli and Klebsiella pneumoniae were 64.4% and 36.9%, respectively. The prevalences of methicillin resistant strains in Staphylococcus aureus and coagulase negative staphylococcus were 53.2% and 81.2%, respectively. Conclusions The antibiotic resistance rate of clinical bacterial isolates is increasing in trend. The spread of multi-drug resistant strains implies the importance of strengthening the control of infection. Antibiotics should be administrated rationally with consideration of the characteristics of epidemiology and drug resistance profile of pathogens in department of hematology.