急性白血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 in bloodstream infections of patients with acute leukemia

目的探讨急性白血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。方法选取自2013年1月1日至2016年7月31日临床送检的急性白血病患者血培养标本,分离并分析病原菌。结果 343份急性白血病患者血培养标本中,共分离出病原菌42株,阳性率为12.2%(42/343)。其中,革兰阴性菌31株(73.8%),主要为大肠埃希菌20株(47.4%);革兰阳性菌8株(19.2%),主要为金黄色葡萄球菌和凝固酶阴性葡萄球菌各2株(4.8%);真菌3株(7.0%),均为热带假丝酵母菌。革兰阴性菌对美罗培南、亚胺培南、哌拉西林/他唑巴坦最敏感,对阿米卡星较敏感;对哌拉西林、头孢呋辛、头孢唑林、头孢曲松及氨苄西林耐药性最高,对环丙沙星、左氧氟沙星及复方新诺明耐药性较高。革兰阳性菌对万古霉素、利奈唑胺、替加环素、庆大霉素及利福平最敏感;对克林霉素、红霉素、青霉素、四环素及复方新诺明耐药性最高。热带假丝酵母菌对伏立康唑、氟康唑、氟胞嘧啶敏感,其中,1株对两性霉素敏感。结论急性白血病患者血流感染发生率高且病原菌种类多,其主要病原菌为革兰阴性菌,美罗培南、亚胺培南等可作为首选抗菌药物;严重葡萄球菌血流感染首选药物为万古霉素、利奈唑胺等;真菌感染时,伏立康唑、氟康唑、氟胞嘧啶疗效较好。

Objective To investigate the pathogenic bacteria distribution and drug resistance in bloodstream infections of patients with acute leukemia and to provide the basis for rational application of antibiotics in clinic. Methods A retrospective study was performed on the positive results of blood culture in patients with acute leukemia from January lst,2013 to July 31st ,2016 and the pathogenic bacteria was isolated and analyzed. Results Among the total of 343 blood cultures in patients with acute leukemia, the identified strains were 42, the positive rate was 12. 2% （42/343）. There were 31 （73.8%） strains of Gram-negative （G-） bacteria, mainly 20（47. 4% ） strains of Escherichia coli; Gram-positive（ G ＋ ） bacteria were 8 （ 19. 2% ） strains, the main bacteria was staphylococcus aureus and eoagulase-negative staphylococcus ,2 （4. 8% ） strains in each bacteria, and 3 （7.0%） strains of fungi, both of them were Candida tropicalis. G- bacteria was the most sensitive to meropenem, imipenem and piperacillin/tazobactam, was more sensitive to ami- kacin;G bacteria has the highest resistance rate to piperacillin, cefuroxime, cefazolin, cefiriaxone and ampieillin;G bacteria has the higher resistance rate to ciprofloxacin, levofloxacin and trimethoprim-sulfamethoxazole. G ＋ bacteria was the most sensitive to vancomycin, linezolid, tigecycline, gentamicin and rifampicin; G ＋ bacteria has the highest resistance rate to clindamycin, erythromycin, penicillin, tetracycline and trimethoprim-sulfamethoxazole. Candida tropicalis were sensitive to voriconazole, fluconazole and flucytosine and including 1 strain had the sensitivity to amphotericin. Conclusion At present it has high incidence of bloodstream infections of different pathogenic bacteria for patients with acute leukemia. G-bacteria is still the main pathogenic bacteria of bloodstream infection and meropenem,imipenem are the drugs of the first choice. When serious staphylococcus bloodstream infection happens, linezolid and van- comycin are the best choice. The resistance of pathogenic bacterium is increased to the antimierobials which has been commonly used in hospital. Accordingly, active prevention and cure of the infection should be performed to reduce the fatality rate.