血液病科2011-2013年临床标本分离病原菌及耐药性分析

Distribution and antimicrobial resistance of clinically isolated pathogens in hematology department from 2011 to 2013

目的分析血液病科近3年临床送检标本病原菌分布及耐药情况。方法收集2011年1月-2013年12月血液病科住院患者送检标本分离菌株，使用K—B法或自动化仪器法进行药敏检测，抗菌药物药敏结果判定依照美国临床试验标准化委员会（CLSI）2011年版指南，应用WHONET5．6软件进行数据统计分析。结果2011—2013年血液病科临床送检标本共分离病原菌462株，其中革兰阳性球菌161株，革兰阴性杆菌279株，真菌22株。葡萄球菌属中耐甲氧西林凝固酶阴性葡萄球菌（MRSCN）及耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为81．37％和62．50％。葡萄球菌属及肠球菌属细菌对利奈唑胺耐药率分别为1．69％及3．57％，葡萄球菌属细菌对替考拉宁耐药率为3．39％，未检出对万古霉素耐药的革兰阳性球菌。肠杆菌科中大肠埃希菌、肺炎克雷伯菌对碳青霉烯类抗生素高度敏感（敏感率为97．56％～98．88％）；而非发酵革兰阴性杆菌铜绿假单胞菌及鲍曼不动杆菌对碳青霉烯类抗生素耐药明显（耐药率为38．71％～64．00％）。结论血液病科主要细菌耐药现象较重，应根据血液病科细菌分布的特点及药敏结果，有针对性地合理应用抗菌药物，加强医院感染控制措施，降低细菌耐药率。

Objective To analyze the distribution and antimierobial resistance of pathogens isolated from department of hematology during the past three years. Methods Pathogenic strains isolated from patients hospitalized in a hematology de- partment between January 2011 and December 2013 were collected, antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method or automatic system, antimicrobial susceptibility testing results were judged according to American Clinical and Laboratory Standards Institute 2011, data were analyzed by WHONET 5.6 software. Results A total of 462 clinical isolates were collected in 2011--2013, including 161 gram-positive cocci isolates, 279 gram- negative bacilli, and 22 fungi. Of Staphylococcusspp, detection rate of methicillin-resistant coagulase negative Staphylo- coccus（MRCNS） and methicillin-resistant Staphylococcus aureus （MRSA） was 81.37 % and 62. 50 % respectively. The re- sistant rate of Staphylococcus spp. and Enterococcus spp. to linezolid was 1.69% and 3.57% respectively, resistant rate of Staphylococcus spp. to teicoplanin was 3.39%, vancomycin-resistant gram-positive coccus was not found. Enterobacte- riaceae strains Escherichia coli and Klebsiella pneumoniae were highly susceptible to carbapenems, the sensitivity rates were 97. 56 %-98.88 % ; while nonfermentative gram-negative bacilli Pseudornonas aeruginosa and Acinetobacter bauman- nil strains were obviously resistant to carbapenems, the resistance rates were 38.71%--64. 00 %. Conclusion Antimicrobial resistance of major pathogenic strains from hematology department is high, antimicrobial agents should be used according to pathogenic distribution characteristics and antimicrobial susceptibility testing results, healthcare-associated infection control should be strengthened to reduce antimicrobial resistant rate.