2013-2018年恶性血液病患者血流感染病原菌与耐药性变迁

Changes of distribution and antimicrobial resistance of pathogens in hematologic malignancies patients with bloodstream infection in 2013-2018

目的了解恶性血液病患者医院获得性血流感染病原菌分布及耐药变迁特点,为临床感染控制合理用药及治疗提供数据支持。方法回顾性调查2013年7月-2015年11月和2015年12月-2018年3月1072例恶性血液病医院获得性血流感染患者血培养标本检出信息,分析两个时间段血流感染病原菌及耐药性变迁趋势。结果 1 072例患者血培养共检出病原菌927株,其中革兰阴性菌480株占51.78%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌421株占45.42%,以表皮葡萄球菌和人葡萄球菌为主;真菌26株占2.80%,以热带假丝酵母为主;近五年人葡萄球菌和表皮葡萄球菌对青霉素、甲氧西林和磺胺甲噁唑/甲氧苄啶的耐药率较高,均未发现万古霉素、替考拉宁、利奈唑胺和利福平耐药株;表皮葡萄球菌对克林霉素的耐药率由21.74%上升至41.30%(P=0.024);热带假丝酵母对两性霉素B和氟胞嘧啶较敏感;主要革兰阴性菌对亚胺培南和阿米卡星仍较敏感。结论应加强血流感染病原菌和耐药变迁差异监测,科学合理用药,有效减缓细菌耐药性增长和控制血流感染。

OBJECTIVE To explore the changes of distribution and drug resistance of pathogens isolated from blood samples in hematologic malignancies patients with hospital acquired bloodstream infection,so as to provide data support for rational drug use and treatment of clinical infection control.METHODS The blood culture samples from 1072 patients with hospital acquired bloodstream infection from Jul.2013 to Nov.2015 and Dec.2015 to Mar.2018 were retrospectively analyzed.Changes of distribution and antimicrobial resistance of pathogens in two time periods were analyzed.RESULTS A total of 927 pathogens were detected from blood samples of 1072 cases of patients,including 480 strains of gram-negative bacteria accounting for 51.78%,mainly Escherichia coli and Klebsiella pneumoniae,421 strains of gram-positive bacteria accounting for 45.42%,mainly Staphylococcus epidermidis and S.hominis,and 26 strains of fungi accounting for 2.80%,mainly Candida tropicalis.In recent 5 years,the resistant rates of S.epidermidis and S.hominis to penicillin,methicillin and sulfamethoxazole/trimethoprim were high,and no vancomycin,teicoplanin,linezolid and rifampin resistant strains were found.The resistance rate of S.epidermidis to clindamycin increased from 21.74%to 41.30%（P=0.024）.C.tropicalis was sensitive to amphotericin B and flucytosine.The main gram-negative bacteria were sensitive to imipenem and amikacin.CONCLUSION We should strengthen the monitoring of changes of pathogens and drug resistance of bloodstream infection,scientifically and rationally use drugs,effectively slow down the growth of drug resistance and control bloodstream infections.