白血病患者化疗期间感染病原菌分布及耐药性分析

Distribution and antibiotic resistance of pathogens causing infections in leukemia patients during chemotherapy

目的探讨白血病患者化疗期间感染病原菌分布及对抗菌药物的耐药性,为临床抗感染治疗提供帮助。方法选择医院2010年3月-2012年3月收治白血病化疗患者117例,收集体液及粪便标本,进行病原菌检测及药敏试验,并对感染病原菌种类、感染部位分布以及耐药性进行统计分析。结果共分离出病原菌147株,其中革兰阳性菌38株占25.9%;革兰阴性菌81株占55.1%;真菌28株占19.0%,排名前4位的病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌及克雷伯菌属,分别占20.4%、12.9%、11.6%、10.2%;患者主要感染部位为呼吸系统、泌尿系统及消化系统,其中呼吸系统感染明显高于其他部位,差异有统计学意义(P<0.05);病原菌对于青霉素、氨苄西林、头孢哌酮、头孢哌酮/舒巴坦、头孢噻肟及亚胺培南等抗菌药物耐药性较高,耐药率分别为92.5%、61.9%、46.3%、31.3%、42.9%及26.5%,而对于万古霉素敏感,敏感率达100.0%;青霉素耐药率明显高于其他抗菌药物,差异有统计学意义(P<0.05)。结论白血病患者化疗期间感染病原菌具有种类多、感染部位及耐药谱广等特点,临床应早期行药敏试验,选择敏感抗菌药物进行治疗。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing infections in the leukemia patients during the chemotherapy so as to guide the clinical anti-infection therapy.METHODS A total of 117 patients with leukemia,who underwent the chemotherapy in the hospital from Mar 2010 to Mar 2012,were enrolled in the study,then the body fluid and stool specimens were collected for the detection of pathogens and the drug susceptibility testing,finally,the species of pathogens,infection sites,and drug resistance were statistically analyzed.RESULTS In this study,147 strains of pathogens were isolated,including 38strains of gram-positive bacteria（25.9%）,81 strains of gram-negative bacteria（55.1%）,and 28 strains of fungi（19.0%）;the Escherichia coli,Staphylococcus aureus,Pseudomonas aeruginosa and Klebsiellaranked the top four species of pathogens,accounting for 20.4%,12.9%,11.6%,and 10.2%,respectively.The respiratory system,urinary system,and digestive system were the predominant infection sites,and the incidence of respiratory system infections was significantly higher than that of other sites,the difference was statistically significant（P0.05）.The drug resis tance rates of the pathogens to penicillin,ampicillin,cefoperazone,cefoperazone-sulbactam,cefotaxime,and imipenem were 92.5%,61.9%,46.3%,31.3%,42.9%,and 26.5%,respectiveng,however,the strains were sensitive to vancomycin;the drug resistance rate to penicillin was significantly higher than that to other types of antibiotics（P0.05）.CONCLUSIONThe leukemia patients with infections caused by a variety of species of pathogens are characterized by the multiple infection sites and the broad spectrum of drug resistance.It is necessary for the hospital to carry out the drug susceptibility testing in the early stage and choose sensitive antibiotics for the treatment.