恶性肿瘤患者血培养分离菌的分布及耐药性

Distribution and Resistance of Bacterial Isolated from Blood of Malignant Tumour Patients

目的了解恶性肿瘤患者血培养分离菌的分布和耐药特征。方法对2013年1月—2015年12月血培养分离菌的分布及其耐药性进行统计分析,采用CLSI2014年版标准进行结果判断。结果血培养分离菌498株,革兰阳性菌占42.0%,革兰阴性菌占58.0%,未检出真菌;病原菌前5位依次是大肠埃希菌,凝固酶阴性葡萄球菌,克雷白杆菌属,金黄色葡萄球菌,肠球菌属。大肠埃希菌对哌拉西林/他唑巴坦、阿米卡星和亚胺培南耐药率低,对氨苄西林/舒巴坦、庆大霉素、环丙沙星、左氧氟沙星和复方磺胺甲叮恶唑耐药率高。产超广谱β-内酰胺酶大肠埃希菌和克雷白杆菌属检出率分别为70.7%和22.8%。大肠埃希菌和克雷白杆菌属对大多数抗菌药的耐药率以重症监护室最高,其次是肿瘤外科。屎肠球菌对高浓度庆大霉素耐药率低,对其他受试药物耐药率较高,并显著高于粪肠球菌,未检出万古霉素耐药肠球菌。结论肿瘤患者血培养分离的革兰阴性菌中大肠埃希菌和肺炎克雷白杆菌常见,革兰阳性菌中葡萄球菌和肠球菌为主,重症监护室中分离菌不动杆菌属比例相对较高,临床可根据细菌耐药性监测合理选择抗菌药物。

Objective To investigate the distribution and susceptibility of isolated organisms from blood of malignant tumour patients. Methods Isolates from blood culture in patients with cancer during January 2013 to December 2015 were analyzed. Results were analyzed according to the breakpoints of CLSI 2014. Results Total of 498 isolates from blood culture,gram-negative bacilli accounted for 58. 0% and gram-positive cocci accounted for 42. 0%. The most common pathogens were E.coli,Coagulase-negative Staphylococcus,Klebsiella spp,S. aureus and Enterococcus spp. Drug resistance of E. coli strains to piperacillin-tazobactam,amikacin and imipenem were low,and drug resistance of E. coli strains to ampicillin-sulbactam,gentamicin,ciprofloxacin,levofloxacin and compound sulfamethoxazole were high. The prevalence of ESBL-producing strains was70. 7% in E. coli and 22. 8% in Klebsiella spp. The E. coli and Klebsiella spp. strains isolated from ICU showed higher resistance than the strains from surgery and medicine department. The E. faecium strains were highly susceptible to gentamicin（ high level）and lower susceptible to most of the antibiotics tested. The E. faecalis strains were more susceptible than E. faecium to these agents. No vancomycin-resistant strains were found in Enterococcus spp. Conclusion Among gram-negative pathogen isolates from blood culture in cancer patients,E. coli and Klebsiella spp. are the most frequent. Staphylococcus and Enterococcus are the most frequently isolated species of gram-positive cocci. The percentage of Acinetobacter spp. strains is relatively higher in ICU.Surveillance of antimicrobial resistance can provide the basis for rational use of antibiotics.