恶性肿瘤化疗患者败血症病原菌分布与药敏分析

Distribution and drug susceptibility analysis of pathogens causing sepsis in patients with malignant tumor chemotherapy

目的调查恶性肿瘤化疗患者败血症的病原菌谱及其耐药性,为临床治疗提供参考依据。方法回顾性分析医院2009年1月-2012年12月203例恶性肿瘤患者化疗后发生败血症的临床资料,将其中96例发生粒细胞缺乏患者为A组,107例未发生粒细胞缺乏患者为B组,比较两组病原菌分布及耐药性。结果 203例化疗并发败血症患者共培养出病原菌210株,革兰阴性杆菌146株占69.5%,以大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌为主,分别占29.0%、17.1%及7.1%;革兰阳性球菌63株占30.0%,主要为凝固酶阴性葡萄球菌、肠球菌属和金黄色葡萄球菌,分别占10.0%、7.6%和5.2%;革兰阴性杆菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星及左氧氟沙星较敏感,对其他抗菌药物耐药率较高;革兰阳性球菌对万古霉素、替考拉宁及利奈唑胺均敏感,对其余抗菌药物均有不同程度耐药;A组检出的病原菌对抗菌药物耐药率普遍高于B组。结论恶性肿瘤化疗患者败血症病原菌感染以革兰阴性杆菌为主,感染患者的病原菌耐药严重,临床应根据药敏结果选择合适的抗菌药物。

OBJECTIVE To study distribution and drug susceptibility of pathogens causing sepsis in patients with malignant tumor chemotherapy so as to offer references for clinical treatment .METHODS Totally 203 cases of pa‐tients undergoing chemotherapy with septicemia in Sun Yat‐Sen memorial hospital from Jan .2009 to Dec .2012 were retrospectively analyzed .Totally 96 cases of patients with agranulocytosis were chosen as group A and 107 cases without agranulocytosis were selected as group B .The distribution and drug resistance rate of pathogens were compared in the two groups .RESULTS A total of 210 strains of bacteria were cultivated from the 203 cases of patients with chemotherapy and suffered from sepsis .Of them ,146 strains were gram‐negative bacteria ,account‐ing for 69 .5% .And Escherichia coli , K lebsiella pneumoniae and Pseudomonas aeruginosa were the dominant gram‐negative bacteria , accounting for 29 .0% , 17 .7% and 7 .1% . Gram‐positive bacteria with 63 strains （30 .0% ） were mainly coagulase‐negative Staphylococci ,Enterococcus and Staphylococcus aureus ,accounting for 10 .0% ,7 .6% and 5 .2% .Gram‐positive bacteria were sensitive to imipenem ,piperacillin/tazobactam ,amikacin and levofloxacin while resistant to other antibiotics .Gram‐positive bacteria were sensitive to vancomycin ,teicopla‐nin and linezolid and also showed drug resistance to other antibiotics .The drug resistance rate in the group A was higher than that in group B in general .CONCLUSION The gram‐negative bacteria were the superior pathogens cau‐sing septicemia in patients undergoing chemotherapy .Pathogens in infected patients have severe drug resistance and proper antibiotics should be chosen according to drug sensitivity results .