血液病并发感染的病原学及耐药性分析

Etiology and Drug Resistance Analysis of Hematological Diseases Complicated with Infection

目的探索血液病患者感染的临床特征及病原菌耐药性,为合理使用抗生素提供证据。方法回顾性分析了125例次标本阳性血液病患者的临床特点及病原菌的耐药性。结果院内感染检出率(79.2%)明显高于入院前(20.8%)(P<0.05),恶性血液病检出率(73.6%)明显高于非恶性血液病(26.4%)(P<0.05)。老年患者检出率(65.6%)明显高于非老年(34.4%)(P<0.05);白细胞<4×109/L检出率(57.6%)明显高于白细胞≥4×109/L检出率(42.4%)(P<0.05)。最常见细菌感染部位为呼吸道感染最常见48.8%,其次泌尿道感染25.6%,血流感染21.6%,消化道感染2.4%,皮肤感染1.6%。主要病原菌类型是革兰阴性菌,占55.2%,其中肺炎克雷伯杆菌占19.2%、大肠埃希菌占17.6%、铜绿假单胞菌占9.6%。酵母样真菌感染位于第二位,占24.8%;革兰阳性菌相对较低,仅占20%。革兰阴性菌耐药比较严重,对多种常用抗生素耐药,对碳青霉烯类、酶抑制剂复合制剂仍有较好敏感性。葡萄球菌对多肽类、唑烷酮类抗生素仍较敏感。多重耐药率6.4%,其中耐甲氧西林金黄色葡萄球(MRSA)占4.8%,耐碳青霉烯类肠杆菌科细菌(CRE)1.6%。结论血液病患者易并发感染,临床应根据检出病原菌敏感及耐药性,合理选择抗菌药物。

Objective To explore the clinical features and drug resistance of pathogens in patients with hematological diseases, and to provide evidence for rational use of antibiotics. Methods The clinical features of 125 patients with positive blood diseases and the drug resistance of the pathogens were retrospectively analyzed. Results The detection rate of nosocomial infection （ 79.2% ） was significantly higher than that before hospitalization（20.8% ） （P 〈 0.05 ）. The detection rate in malignant blood disease （73.6%） was significantly higher than that in non-malignant blood disease （26.4%） （P 〈 0.05 ）. The detection rate in elderly patients （ 65.6% ） was significantly higher than that in non-elderly （ 34.4% ） （ P 〈 0.05 ）. The detection rate in less than 4 x 109/L white blood ce11（57.6% ） was significantly higher than that in more than 4 x 109/L white blood cells （ 42.4% ） （ P 〈 0.05 ）. Respiratory tract infection （ 48. 8% ） was the most common bacterial infection sites, followed by urinary tract infection （25. 6% ）, bloodstream infection （21.6%）, digestive tract infection（2.4% ）, and skin infections（ 1.6% ）. The main pathogens were gram- negative bacteria accounted for 55. 2%, Klebsiella pneumoniae accounted for 19. 2%, Escherichia coli accounted for 17.6%, and pseudomonas aeruginosa accounted for 9.6%. Yeast like fungal infection was located in second place, accounting for 24.8 % ; gram-positive bacteria were relatively low, accounting for only 20%. Gram-negative bacteria resistance to antibiotics was more serious, but there was still a good sensitivity to carbapenems and enzyme inhibitors. Staphylococci were still sensitive to peptides and oxazolidinones. The rate of multiple drug resistance was 6.4%, including methicillin resistant staphylococcus aureus （MRSA） accounted for about 4.8 % and carbapenem resistant enterobacteriaceae （CRE） accounted for 1.6%. Conclusion The patients with hematological disease were easy to be infected, so rational selection of antibiotics should be chosen according to detection of pathogenic bacteria sensitivity and drug resistance.