血液系统疾病患者医院感染病原菌分布与耐药性分析

Clinical characteristics of nosocomial infections in patients with blood diseases

目的探讨医院血液系统疾病住院患者医院感染病原菌分布及其耐药性,为临床抗菌药物应用提供参考依据。方法回顾性分析2011-2013年医院收住的血液系统疾病3 652例患者发生医院感染病原菌分布及其药敏试验结果,所有数据应用SPSS16.0软件进行统计分析。结果医院血液系统疾病医院感染率为19.25%,感染部位以呼吸道为主,占58.32%;临床分离的病原菌703株,其中革兰阴性菌516株占73.40%,革兰阳性菌151株占21.48%,真菌36株占5.12%;常见革兰阴性菌对β-内酰胺酶抑制剂、氨基糖苷类、碳青酶烯类耐药率低,革兰阳性菌对利福平、呋喃妥因、万古霉素、替考拉宁、利奈唑胺、夫西地酸耐药率低。结论针对血液系统疾病患者特殊人群,医院感染的控制应尽早明确疾病类型、合理使用抗菌药物、改善住院条件、骨髓抑制期及时转入层流病房等。

OBJECTIVE To explore the clinical characteristics of nosocomial infections in the hospitalized patients with blood diseases and investigate the distribution and drug resistance of the pathogens so as to control the noso‐comial infections .METHODS A total of 3 652 patients with blood diseases who were hospitalized from 2011 to 2013 were enrolled in the study ,then the distribution and drug susceptibility rates of the pathogens causing nosocomial infections were retrospectively analyzed ,and all the data were statistically analyzed with the use of SPSS 16 .0 soft‐ware .RESULTS The incidence of nosocomial infections was 19 .25% in the patients with blood diseases ,and the incidence of nosocomial infections was highest （24 .89% ） in the patients with leukemia ,followed by the patients with lymphoma （14 .94% ） and the patients with multiple myeloma （9 .96% ） .Of the patients with nosocomial in‐fections ,58 .32% had respiratory tract infections ,19 .91% had bloodstream infections ,and 14 .94% had urinary tract infections .Totally 703 strains of pathogens were isolated from clinical specimens ,including 516 （73 .40% ） strains of gram‐negative bacteria ,151 （21 .48% ） strains of gram‐positive bacteria ,and 36 （5 .12% ） strains of fungi .The drug resistance rates of the common gram‐negative bacteria to β‐ lactamase inhibitors ,aminoglyco‐sides ,and carbapenems were low ;the drug resistance rates of the gram‐positive bacteria to rifampicin ,nitrofuran‐toin ,vancomycin ,teicoplanin ,linezolid ,and fusidate were low .CONCLUSION As a special population ,the pa‐tients with blood diseases are at high risk of nosocomial infections ,and it is necessary to try to confirm the types of diseases as early as possible ,reasonably use antibiotics ,improve the hospitalization condition ,and tranfer to the laminar air flow ward during the bone marrow suppression period in a timely mahner so as to control the nosocomial infections .