中性粒细胞缺乏伴发热患者临床分离菌的分布及药敏分析

Bacterial species and antimicrobial susceptibility profile of pathogens in febrile neutropenic patients

目的研究中性粒细胞缺乏(粒缺)伴发热患者致病细菌的分布及其耐药性现状。方法回顾性分析2005年1月—2012年12月上海市第一人民医院血液科粒缺伴发热患者临床分离菌的分布及药敏特点。采用纸片扩散法(K-B)进行药敏试验,并按CLSI 2014年版标准判断结果。结果共检出粒缺伴发热患者临床分离菌355株,其中革兰阳性菌占29.6%,革兰阴性菌占70.4%。铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌和溶血葡萄球菌分别排在所有致病菌前6位。不发酵糖革兰阴性杆菌占革兰阴性菌的53.2%。甲氧西林耐药金黄色葡萄球菌(MRSA)及甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的检出率均已达100%,未检出对糖肽类和(或)唑烷酮类耐药的葡萄球菌和肠球菌。铜绿假单胞菌对亚胺培南和美罗培南的敏感率较低,分别为40.8%和59.2%,对头孢哌酮-舒巴坦、哌拉西林-他唑巴坦、头孢吡肟等的敏感率大于70%。肺炎克雷伯菌对美罗培南和亚胺培南等碳青霉烯类抗生素敏感率达100%,对头孢哌酮-舒巴坦、阿米卡星等的敏感率大于70%。鲍曼不动杆菌对碳青霉烯类抗生素、头孢哌酮-舒巴坦、头孢吡肟、环丙沙星及氨基糖苷类等的敏感率均大于80%。大肠埃希菌对碳青霉烯类仍保持100%敏感,对头孢哌酮-舒巴坦、头孢他啶等的敏感率大于70%。嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素、头孢哌酮-舒巴坦、甲氧苄啶-磺胺甲唑的敏感率均大于90%。结论粒缺伴发热患者致病菌以革兰阴性菌为主,肠杆菌科细菌和不发酵糖革兰阴性杆菌常见,耐药情况较严重。葡萄球菌属100%甲氧西林耐药。掌握本地粒缺伴发热致病细菌的分布及药敏现状对经验性抗感染治疗方案的选择有重要的参考价值。

Objective To examine the distribution of bacterial species and antimicrobial susceptibility profile of pathogens in febrile neutropenic patients. Methods A total of 355 bacterial strains were isolated from febrile neutropenic patients in Shanghai General Hospital from January 2005 to December 2012. Antimicrobial susceptibility testing was done by Kirby-Bauer method. The susceptibility testing results were analyzed according to CLSI 2014 breakpoints. Results Gram-negative bacteria accounted for70.4% of the 355 isolates, while gram-positive organisms accounted for 29.6%. The most common bacterial species were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Stenotrophomonas maltophilia and Staphylococcus haemolyticus. Non- fermentative bacteria accounted for 53.2% of all the gram- negative bacterial isolates. All the Enterococcus andStaphylococcus isolates were susceptible to linezolid, vancomycin and teicoplanin. All the Staphylococcus strains were resistant to methicillin. P. aeruginosa isolates were relatively more susceptible to cefoperazone-sulbactam, piperacillin-tazobactam and cefepime （〉70%） than imipenem （40.8%） and meropenem （59.2%）. All the K. pneumoniae isolates were susceptible to imipenem and meropenem and more than 70% of the isolates were susceptible to cefoperazone-sulbactam, amikacin. More than 80% of the A. baumannii isolates were susceptible to carbapenems, cefoperazone-sulbactam, amikacin, ciprofloxacin and aminoglycosides. All the E. coli isolates were susceptible to carbapenems and more than 70% were susceptible to cefoperazone-sulbactam and ceftazidime. More than 90% of the S. maltophilia strains were sensitive to levofloxacin, minocycline, cefoperazone-sulbactam and trimethoprim- sulfamethoxazole. Conelusions Our data suggest that gram-negative bacteria, especially Enterobacteriaceae and non-fermentative bacteria, are still the primary pathogens in febrile neutropenic patients. Antimicrobial resistant strains are prevalent. Such data of bacterial species and antimicrobial susceptibility profile of pathogens in febrile neutropenic patients are useful for empirical antimicrobial therapy of such infections.