恶性肿瘤患者医院感染多药耐药菌的药敏结果及危险因素分析

Drug susceptibility testing for multidrug-resistant organisms causing nosocomial infection in malignant tumor patients and analysis of risk factors

目的深入了解恶性肿瘤患者医院感染多药耐药菌的现状,为降低和控制多药耐药对恶性肿瘤患者造成的伤害提供科学根据。方法选取2014年1月-2016年1月医院收治的1 538例恶性肿瘤患者,筛选出多药耐药菌感染者,对其进行药敏性和危险因素分析。结果 1 538例恶性肿瘤患者中,发生多药耐药菌感染患者共60例,感染率为3.9%;60例发生多药耐药菌感染患者的标本中,分离出耐药菌株98株,以革兰阴性菌为主,67株占68.3%;大肠埃希菌和肺炎克雷伯菌ESBLs菌株检出率为94.7%和86.7%;革兰阳性菌31株占31.6%,MRSA和MRCNS检出率分别为66.7%和72.7%;而耐药菌株对抗菌药物敏感性均较低,革兰阴性菌除外鲍氏不动杆菌和嗜麦芽寡养单胞菌,只对亚胺培南敏感;革兰阳性菌所有菌株对头孢类抗菌药物均有着极强的耐药性,同时还检测出1株肠球菌对万古霉素耐药;患者的年龄、是否合并高血压、糖尿病、是否存在意识障碍、侵入性操作以及住院时间是其发生多重感染的主要危险因素。结论多药耐药菌感染是恶性肿瘤患者死亡的重要原因,甚至是导致其死亡的直接原因;因此对恶性肿瘤患者多药耐药菌感染危险因素和药敏情况进行分析,对降低恶性肿瘤患者的耐药菌感染率以及降低因感染而导致的病死率有着重要意义。

OBJECTIVE To further understand the current statue of prevalence of nosocomial infections caused by multidrug-resistant organisms （MDROs） in malignant tumor patients so as to provide scientific basis for prevention and control of harms to the malignant tumor patients.METHODS A total of 1 538 malignant tumor patients who were treated in the hospital from Jan 2014 to Jan 2016 were enrolled in the study,the patients with MDROs infections were screened out,the drug susceptibility testing was performed,and the risk factors were analyzed.RESULTS Of the 1 538 malignant tumor patients,totally 60 had the MDROs infections,with the infection rate of 3.9 %.A total of 98 strains of drug-resistant pathogens were isolated from the specimens of the 60 patients with MDROs infection,of which 67 （68.3%） were gram-negative bacteria.The isolation rates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae were 94.7% and 86.7%,respectively.There were 31 （31.6%）strains of gram-positive bacteria,and the isolation rates of MRSA and MRCNS were 66.7% and 72.7%,respectively.The drug susceptibility rates of the drug-resistant strains were relatively low,and all of the gram-negative bacteria,except for Acinetobacter baumannii and Stenotrophomonas maltophilia,were only susceptible to imipenem.All of the gram-positive bacteria showed extremely high resistance to cephalosporins,meanwhile,1 strain of vancomycin-resistant Enterococcus was isolated.The major risk factors for the MDROs infections included age,complication with hypertension,diabetic mellitus,disturbance of consciousness,invasive operations,and length of hospital stay.CONCLUSION The MDROs infection is a leading cause of death of the malignant tumor patients or even an immediate cause of death,therefore,it is of great significance to investigate the risk factors for the MDROs infections in the malignant tumor patients and analyze the result of drug susceptibility testing so as to reduce the infection rate and the rate of death due to the infections.