急性白血病患者合并感染的菌群分布及耐药性分析

Analysis on bacterial flora distribution and drug resistance in patients with acute leukemia complicating infection

目的研究分析急性白血病患者合并感染的病原菌种类、菌群分布及耐药性情况。方法收集大连医科大学附属第一医院2011年1月至2015年12月血液科收治的急性白血病患者1 292例,采集临床标本进行细菌培养鉴定及药敏实验,分析其菌群分布及耐药率。结果急性白血病患者合并感染的感染率为30.57%。以呼吸道感染为主,占47.85%;其次为血液感染占20.97%。分离出的病原菌中革兰阴性菌为367株(65.77%),革兰阳性菌为142株(25.45%),真菌49株(8.78%)。革兰阴性菌中以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主。革兰阳性菌中以凝固酶阴性葡萄球菌、金黄色葡萄球菌为主。真菌则主要是白色假丝酵母菌为主。碳青霉烯类和加酶抑制剂药物在革兰阴性菌感染中敏感率最高,在90.00%以上。革兰阳性菌感染中糖肽类和达托霉素的敏感率都是100.00%,其次是替卡西林/棒酸,敏感率是84.93%。感染的真菌所用的抗真菌药物,敏感率都是100.00%。结论急性白血病患者合并感染的感染率较高,并以呼吸道感染为主。革兰阴性菌是主要病原菌且对碳青霉烯类敏感率较高,革兰阳性菌和真菌在感染中也占有较高比例。

Objective To study the species of pathogenic bacteria,bacterial flora distribution and drug resistance in the patients with acute leukemia complicating infection.Methods A total of 1 292 patients with acute leukemia in the First Affiliated Hospital of Dalian Medical University from January 2011 to December 2015 were collected.Clinical samples were collected to perfom the bacterial culture and identification,and drug susceptibility test.Then the flora distribution and drug resistance were analyzed.ResultsThe infection rate in the patients with acute leukemia complicating infection was 30.57%.Respiratory infection was predominant,accounting for 47.85%,followed by blood infection,accounting for 20.97%.Three hundreds and sixty-seven isolated strains were Gram-negative bacteria（65.77%）,142 strains were Gram-positive bacteria（25.45%）and 49 strains were fungi（8.78%）.Klebsiella pneumoniae,E.coli and Pseudomonas aeruginosa were as main part in Gram-negative bacteria.Coagulase negative staphylococcus aureus and Staphylococcus aureus were as main part in Gram-positive bacteria.Candida albicans was the main part in fungi.Carbapenems and enzyme inhibitors had the highest sensitivity in Gram-negative bacterial infection,which was more than 90.00%.In the Gram-positive bacteria infection,glycopeptides and daptomycin had the sensitivity rate of 100.00%,the second was ticarcillin/clavulanate with the sensitivity rate of 84.93%.The antifungal drugs′sensitive rates used in the fungal infection were all 100.00%.Conclusion The infection rate in the patients with acute leukemia complicating infection is higher,and is dominated by respiratory tract infection.Gram-negative bacteria are the main pathogenic bacteria,and have higher sensitivity to carbapenems,Gram-positive bacteria and fungi also have a higher proportion in infection.