2010—2014年血液病患者细菌感染的微生物学及临床特点分析

Pathogens and clinical characteristics of bacterial infection in hematology department between 2010and 2014

目的分析2010年1月至2014年12月血液科不同病房住院患者细菌感染的病原学分布特点、耐药情况及临床特点。方法采用Kirby．Bauer纸片扩散法进行药敏试验，采用WHONET5．6软件进行细菌菌株及耐药性分析；采用SPSS17．0及R3．0统计软件对临床数据进行统计分析。结果2843例患者共送检标本3312份，其中596例患者共培养出634株（19．14％）阳性菌株，其中血液来源488株（76．97％）。革兰阴性菌427株（67．35％），大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌分列前3位，是主要的病原菌，对亚胺培南耐药率分别为0．8％、11．8％、3．3％；大肠埃希菌及肺炎克雷伯菌中产超广谱B内酰胺酶菌株分别占83．9％及75．0％。革兰阳性菌207株（32．65％），主要为凝固酶阴性葡萄球菌、肠球菌及链球菌。凝固酶阴性的葡萄球菌中耐甲氧西林的菌株占65．9％；未发现对万古霉素、利奈唑胺、替加环素耐药的葡萄球菌及肠球菌。结论血液科细菌感染发生率高，血流感染常见，病原菌以革兰阴性菌为主，不同病房细菌分布存在差异。

Objective To analyze the characteristics of distribution and drug resistance of bacterial infection in several different parts of hematology department inpatients of Anhui Provincial Hospital from January 2010 to December 2014, including patients who had received hematopoietic stem cell transplantation（HSCT）. Methods Anti-microbial susceptibility test was done by Kirby-Bauer method and automated systems and the data were analysed by WHONET 5.6 software. Results A total of 3 312 copies of inspection samples were analyzed, including 2 716 （82%） blood samples and other 596 specimens （18%）. 634 bacterial strains were isolated from 3 312 samples （ 19.14% ） including 488 samples （76.97%） from blood culture. 427 （67.35%） bacterial strains were gram-negative, and the other 207 （32.65%） were gram-positive. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were most common gram-negative bacterial and the resistant rates to imipenem were 0.8%, 11.8% and 3.3%, respectively. Detection rates of Extended-spectrum beta-lactamases in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.0%, respectively. At the same time, Coagulase negative Staphylococcus, Streptococcus and Enterococcus were most common kinds of gram-positive bacteria. Methicillin-resistant coagulase negative staphylococcus accounted for 65.9% antibiotic resistance. No vancomycin and/or linezolid and/or tigecycline resistant strains of Staphylococcus spp. and Enterococcus spp. were found in those patients. Conclusion Patients with hematology diseases had a higher risk of bacterial infections, mainly caused by Gram-negative bacteria. There are different distributions of bacterial in different wards.