肿瘤住院患者病原菌感染情况及其耐药性分析

Distribution and drug resistance analysis of pathogen in hospitalized tumor patients

目的:探讨肿瘤住院患者病原菌的感染情况及其对常用抗菌药物的耐药性,为指导临床合理用药和加强医院感染控制提供参考。方法:资料来源于2013年1—12月本院住院患者6 500份临床标本,且经细菌培养,采用仪器法或K-B纸片扩散法进行药敏试验,按照CLSI 2012年标准进行耐药性判断,使用WHONET 5.6软件对细菌临床分布及耐药性情况进行分析。结果:共分离到病原菌2 093株,其中革兰阴性杆菌占55.23%,革兰阳性球菌占11.08%,真菌占33.68%;分离的主要革兰阴性杆菌中前3位依次为肺炎克雷伯杆菌、大肠埃希菌和绿铜假单胞菌,检出率分别为16.63%、9.60%和7.98%;金黄色葡萄球菌和白色假丝酵母菌分别为革兰阳性球菌和真菌的首位。肠杆菌科中大肠埃希菌的耐药性较强,对青霉素类、头孢菌素类和喹诺酮类抗菌药物的耐药率高达60%以上,多药耐药比例较高;葡萄球菌属中,耐甲氧西林金黄色葡萄球菌(MRSA)占10.00%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占87.10%。未发现对万古霉素耐药的金黄色葡萄球菌和凝固酶阴性葡萄球菌。碳青霉烯类药物和万古霉素仍然分别是肠杆菌科细菌和革兰阳性球菌最敏感的药物。结论:肿瘤住院患者易发医院感染,其中革兰阴性杆菌的感染率较高,病原学检查及药敏监测可为临床感染控制和预防及抗菌药物合理应用提供实验依据。

Objective To explore the distribution and drug resistance of pathogen in hospitalized tumor patients and to provide reference for the clinical reasonable use of antibiotics and strengthening the hospital infection control. Methods 6 500 clinical speciments were tested in hospitalized tumor patients from January to December,2013.The drug susceptibilities were tested by automated microbiology system or Kirby-Bauer disk dilution method.Drug susceptibility tests were evaluated according to CLSI standard 2012.WHONET5.6 software data were used to analyze the data.The clinical distribution and the resistance results of bacterial were analyzed retrospectively. Results A total of 2 093 strains of pathogens were isolated from 6 500 clinical speciments,among these strains, the gram-negative bacteria accounted for 55.23%,the gram-positive bacteria accounted for 11.08%,and the fungi accounted for 33.68%.Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa ranked the top three species of pathogens, accounting for 16.63%, 9.60%, and 7.98%, respectively. Staphylococcus aureus, Candidaalbicans ranked the first place of gram-positive bacteria and fungi,respectively.The antibiotic resistance of Escherichia coli was strong in Enterobacteriaceae, and its resistance rates to penicillins,cephalosporins, and quinolones were more than 60%.Of the Staphylococcus,the methicillin-resistant Staphylococcus aureus（MRSA）＆amp;nbsp;accounted for 10.00% and the coagulase-negative Staphylococcus （MRCNS）accounted for 87.10%.There was no vancomycin resistant Staphylococcus aureus and coagulase-negative Staphylococcus detected. Enterobacteriaceae strains were found most sensitive to imipenem;gram-positive bacteria were found most sensitive to vancomycin. Conclusion The hospitalized tumor patients are susceptible to pathogens, and the gram-negative bacteria are the predominant isolated pathogen.Etiology inspection and monitoring of antibiotics sensitivity provide experimental basis for clinical infection control and prevention.