2005～2014年血液系统疾病革兰阳性细菌院内感染情况分析

Analysis of hospital infection with gram positive bacteria from patients with hematological diseases during 2005-2014

目的分析我科血液系统疾病患者革兰阳性细菌院内感染的流行病学、耐药变迁特点及抗感染治疗情况。方法收集2005年1月至2014年12月血液系统疾病患者发生院内感染的标本,其中获得革兰阳性菌株827株,采用微量稀释法进行药敏实验。结果 1革兰阳性菌比例2005-2007年稍有上升趋势,之后呈下降趋势,2012年后再度呈现上升趋势;以金黄色葡萄球菌、表皮葡萄球菌、屎肠球菌、粪肠球菌为主,葡萄球菌比例呈上升趋势,而肠球菌比例呈下降趋势。2与同期革兰阴性菌感染灶比较,分泌物和尿液革兰阳性菌比例更高,而痰液革兰阴性菌比例更高,血液和其他菌株两者比例相近。3各菌株对万古霉素、替考拉宁、利奈唑胺保持高度敏感;金黄色葡萄球菌、表皮葡萄球菌对莫西沙星耐药率略增加,粪肠球菌和屎肠球菌对各抗生素耐药率变化不大;其中耐甲氧西林金黄色葡萄球菌（Methicillin-resistant Staphylococcus aureus,MRSA）占金葡菌的30.6%,低于同期全院指标。4导管相关革兰阳性菌株占所有革兰阳性菌院内感染菌株的比例高于导管相关革兰阴性菌株占所有革兰阴性菌院内感染菌株的比例（P〈0.05）。5对粒细胞缺乏的发热患者,初始经验性抗生素治疗时,抗革兰阴性菌抗生素单药或联合抗革兰阳性菌抗生素,其疗效差异无统计学意义（P〉0.05）。结论本回顾性研究总结了近10年血液系统疾病合并革兰阳性细菌院内感染的流行病学和耐药性等方面的特点,对于指导临床经验性抗生素选择等具有一定的临床价值。

Objective To analyze the epidemiology,antibiotic resistance,and anti-infection treatment of hospital infection with gram positive bacteria from patients who had hematological diseases during 2005-2014.Methods A total of 827 gram positive bacterial strains were isolated from patients with hematological diseases from January2005 to December 2014.Antimicrobial susceptibility testing was done by micro-dilution method.Results 1The percentage of isolated gram positive bacterial strains from secretion and urine was higher than that of gram negative bacillus,while the percentage of isolated gram positive bacterial strains from sputum was lower than that of gram negative bacillus;The percentage of isolated gram positive bacterial strains showed upward during 2005-2007,and then downward,but upward again after 2012;The staphylococcus presented an upward trend,while the enterococcus presented an upward trend;In Staphylococcus aureus,the positive rate of MASA was lower than that of our hospital.2All the isolated gram positive bacterial strains were sensitive to vancomycin,teicoplanin and linezolid,while the resistance rate to moxifloxacin with an upward trend in staphylococcus aureus and staphylococcus epidermidis,and there was no obvious change in Enterococcus faecalis and Enterococcus faecium.3The rate of catheter-related gram positive strains in all gram positive bacterial strains was significantly higher than the rate of catheter-related gram negative bacillus in all gram negative bacillus（P〈0.05）.4No significant difference in efficacy occurred between antibiotics to gram negative bacillus combined with or without antibiotics to gram positive bacteria when used in patients with fever and lack of granulocyte（P〉0.05）.Conclusion Our research summarized the epidemiology,antibiotic resistance of hospital infection with gram positive bacteria,and it is valuable for the choice of rational antimicrobial therapy.