肿瘤患者尿路感染调查分析

Investigation and analysis of urinary tract infections in cancer patients

目的调查分析肿瘤患者尿路感染的病原菌分布及耐药性,为临床治疗提供参考。方法回顾性调查2013年1月-2014年12月住院治疗的肿瘤患者1 548例的临床资料,对其中发生尿路感染的79例患者进行病原学检验及药敏试验。结果 1 548例肿瘤患者中发生尿路感染79例,感染率为5.1%;共分离病原菌104株,其中革兰阳性菌37株占35.6%;革兰阴性菌65株占62.5%;真菌2株占1.9%;粪肠球菌对四环素、红霉素和克林霉素等抗菌药物的耐药率为73.3%~93.3%,凝固酶阴性葡萄球菌对青霉素G、红霉素、环丙沙星和氨苄西林等抗菌药物的耐药率为62.5%~87.5%,大肠埃希菌对头孢曲松、哌拉西林、环丙沙星和左氧氟沙星等抗菌药物的耐药率为65.6%~81.3%,肺炎克雷伯菌对头孢曲松和哌拉西林等抗菌药物的耐药率为66.7%和58.3%,白色假丝酵母菌对伏立康唑和伊曲康唑的耐药率均为50.0%。结论革兰阴性菌为肿瘤患者尿路感染的主要感染菌,加强尿路感染病原菌监测,掌握病原菌分布及耐药性,指导临床合理用药,对于防治医院感染具有重要意义。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing urinary tract infections in cancer patients so as to provide guidance for clinical treatment.METHODS The clinical data of 1 548 cancer patients who were hospitalized for treatment from Jan 2013 to Dec 2014 were retrospectively investigated.The etiological examination was carried out for 79 patients with urinary tract infections,and the drug susceptibility testing was performed.RESULTS Of the 1 548 cancer patients,79 had the urinary tract infections,with the infection rate of 5.1%.A total of 104 strains of pathogens were isolated,including 37（35.6%）strains of gram-positive bacteria,65（62.5%）strains of gram-negative bacteria,and 2（1.9%）strains of fungi.The drug resistance rates of the Enterococcus faecalis to tetracycline,erythromycin,and clindamycin varied from 73.3% to 93.3%;the drug resistance rates of the coagulase-negative Staphylococcus to penicillin G,erythromycin,ciprofloxacin,and ampicillin varied from 62.5%to 87.5%;the drug resistance rates of the Escherichia coli to ceftriaxone,piperacillin,ciprofloxacin,and levofloxacin varied from 65.6%to 81.3%;the drug resistance rates of the Klebsiella pneumoniae to ceftriaxone and piperacillin were 66.7% and 58.3%,respectively;the drug resistance rates of the Candida albicans to both voriconazole and itraconazole were 50.0%.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the urinary tract infections in the cancer patients.It is of great significance to strengthen the surveillance of the pathogens causing the urinary tract infections,understand the distribution and drug resistance of the pathogens,and reasonably use antibiotics so as to prevent nosocomial infections.