血液病患者血流感染病原菌分布及耐药性分析

Analysis on the pathogenic bacteria distribution and drug resistance of blood culture with hematologic diseases

目的探讨血液病患者血流感染的病原菌分布及耐药情况,为临床医师经验性治疗与合理选择抗菌药物提供依据。方法收集沈阳军区总医院2013年1月1日至2016年7月31日临床送检的血液病患者血培养标本,分离并分析病原菌。结果 852份血培养标本中,共分离出病原菌80株,阳性率为9.4%。其中,革兰阴性菌48株,主要为大肠埃希菌;革兰阳性菌27株,主要为凝固酶阴性葡萄球菌;真菌5株,主要为热带假丝酵母菌。整体病原菌分布前3位分别为大肠埃希菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌。革兰阴性菌主要对亚胺培南、美罗培南、哌拉西林/他唑巴坦等敏感,对氨曲南、头孢呋辛、头孢唑林等耐药概率较高;革兰阳性菌主要对万古霉素、利奈唑胺、替加环素等高度敏感,对克林霉素、红霉素、青霉素等耐药概率较高;热带假丝酵母菌对伏立康唑、氟康唑等敏感。结论血液病患者血流感染的主要病原菌是革兰阴性菌,碳青霉烯类药物可作为经验性治疗的首选抗菌药物;糖肽类药物仍是严重葡萄球菌血流感染的首选抗菌药物。

Objective To investigate the pathogenic bacteria distribution and drug resistance of blood culture with hematologic disease and to provide the basis for empiric theraphy and rational application of antibiotics in clinic.Methods A retrospective study was performed on pathogenic bacteria of blood culture from January 1st,2013 to July 31th,2016.Results From a total of 852 blood,80 strains were identified,positive rate was 9.4%.In these strains there were 48 gram-negative bacteria（in which the biggest isolation was escherichia coli）,27 gram-positive bacteria（in which the biggest isolation was coagulase-negative staphylococcus）and 5 fungi（in which the biggest isolation was candida tropicalis）.The top three species with high isolation rate were escherichia coli,coagulase-negative staphylococcus and staphylococcus aureus.Gram-negative bacteria were mainly sensitive to imipenem,meropenem,piperacillin-tazobactam and had a higher resistance rate to aztreonam,cefuroxime,cefazolin.Gram-positive bacteria were principally sensitive to vancomycin,linezolid,tigecyline and were chiefly resistant to clindamycin,erythromycin,penicillin.Candida tropicalis were sensitive to voriconazole,fluconazole.Conclusion Gram-negative bacteria is still the main pathogenic bacteria of bloodstream infection with hematologic diseases.Accordingly,carbapenemes are the drugs of the first choice as empirical antibiotic therapy.Glycopeptide antibiotics are the drugs of the first choice of serious Staphylococcus bloodstream infection.