肿瘤重症患者血流感染病原菌与耐药性分析

Distribution and drug resistance of pathogens causing bloodstream infections in severe cancer patients

目的探讨肿瘤重症患者发生血流感染的病原菌分布及其耐药性,为临床合理用药提供参考依据。方法选取2011年6月-2013年6月医院收治的肿瘤重症发生血流感染患者共121例,对感染患者的送检标本进行病原学检测及药敏试验,药敏试验结果初步统计采用WHONET 5.0软件,数据统计采用SPSS19.0软件。结果 121例患者共分离出病原菌148株,其中革兰阴性菌75株占50.68%,革兰阳性菌51株占34.46%,真菌22株占14.86%;大肠埃希菌对美罗培南和亚胺培南的敏感率最高,均为100.00%;肺炎克雷伯菌对美罗培南和亚胺培南的敏感率最高,均为100.00%;金黄色葡萄球菌对万古霉素和利奈唑胺的敏感率最高,均为100.00%;而表皮葡萄球菌对大部分抗菌药物耐药率均较高,对利福平、万古霉素、利奈唑胺敏感,敏感率均为100.00%。结论肿瘤重症患者发生血流感染的病原菌以革兰阴性菌为主,临床应根据药敏试验结果合理选择抗菌药物,以减少耐药菌株的产生。

OBJECTIVE To explore the distribution and drug resistance of the pathogens causing bloodstream infec‐tions in the severe cancer patients so as to provide guidance for reasonable clinical use of antibiotics .METHODS A total of 121 severe cancer patients with complicated bloodstream infections who were treated from Jun 2011 to Jun 2013 were enrolled in the study ,then the etiological detection was conducted for the submitted specimens obtained from the patients with infections ,the drug susceptibility testing was performed ,the preliminary statistical analysis of the results of the drug susceptibility testing was carried out by using WHONET 5 .0 software ,and the data were statistically analyzed wit the use of SPSS19 .0 software .RESULTS Totally 148 strains of pathogens have been isolated from the 121 patients ,including 75 （50 .68% ） strains of gram‐negative bacteria ,51 （34 .46% ） strains of gram‐positive bacteria ,and 22 （14 .86% ） strains of fungi .The drug susceptibility rates of the Escherichia coli strains to meropenem and imipenem were highest （100 .00% ）;the drug susceptibility rates of the K lebsiella pneu‐moniae strains to meropenem and imipenem were highest （100 .00% ）;the drug susceptibility rates of the Staphy‐lococcus aureus strains to vancomycin and linezolid were highest （100 .00% ）;while the Staphylococcus epidermi‐dis strains were highly resistant to most of the antibiotics ,with the drug susceptibility rates to rifampicin ,vanco‐mycin ,and linezolid of 100 .00% .CONCLUSION The gram‐negative bacteria are the predominant pathogens cau‐sing the bloodstream infections in the severe cancer patients ,and it is necessary for the hospital to reasonably use antibiotics based on the results of the drug susceptibility testing so as to reduce the drug‐resistant strains .