白血病患者化疗后血流感染致病菌和耐药性分析

Pathogen and Drug Resistance of Leukemia Patients after Chemotherapy in Hospital

【目的】探讨白血病患者化疗后血流感染的致病菌分布和耐药性。【方法】对本院325例接受化疗后发生血流感染的白血病患者的临床资料进行分析,探讨其血流感染的致病菌分布情况以及耐药性。【结果】350株致病菌中革兰阳性菌(G^+)100株(28.57%);革兰阴性菌(G^-)245株(70.0%);真菌5株(1.43%);分离出的致病菌中主要以肺炎克雷伯菌(21.14%)、大肠埃希菌(20.57%)、凝固酶阴性葡萄球菌(17.71%)、铜绿假单胞菌(14.29%)以及金黄色葡萄球菌(4.86%)为主;G^-中大肠埃希菌与肺炎克雷伯菌中大多数产超广谱β内酰胺酶(ESBLs)菌株对抗菌药物的耐药性均高于非ESBLs菌株;主要肠杆菌对碳青霉烯药物、替加环素以及哌拉西林的耐药性均较低(小于14%);鲍曼不动杆菌对头孢噻肟和头孢克肟的耐药率均为7.0%,对头孢西丁和头孢唑林的耐药率均高于50.0%,对替加环素敏感;铜绿假单胞菌对各种抗菌药物的耐药率均在12.0%以下;未检测到G^+对利奈唑胺、万古霉素以及替加环素的耐药性。【结论】白血病患者化疗后发生血流感染的致病菌种类较多,以CT为主,耐药情况较严重。利奈唑胺、万古霉素以及替加环素可应用于G^+血流感染患者的治疗。

【Objective】To explore the pathogenic distribution with bloodstream infection and post-chemo-therapy drug resistance in patients with leukemia.【Methods】Retrospective analysis of the clinical data of 325 leukemia patients with blood stream infection after chemotherapy was conducted to investigate the distribution of pathogenic bacteria and drug resistance of blood stream infection.【Results】Among the 350 pathogenic strains we checked,100 were Gram-positive bacteria(G^+)(28.57%),245 were Gram-negative bacteria(G^-)(70.0%)and 5 were fungi(1.43%).The isolated pathogens were mainly Klebsiella pneumoniae(21.14%),Escherichia coli(20.57%),coagulase-negative staphylococci(17.71%),Pseudomonas aeruginosa(14.29%)and golden yellow Staphylococcus(4.86%).Escherichia coli and Klebsiella pneumoniae isolated from Gram-negative bacteria(G^-),which produced the extended-spectrumβ-lactamase,were more resistant to antibiotics than non-ESBLs strains.Enterobacteriaceae(intestinal bacilli)were less resistant to carbapenem drugs,tige-cycline,and piperacillin(less than 14%).The resistance rates of Acinetobacter baumannii to cefotaxime and cefixime were both 7.0%,and their resistance rates to cefoxitin and cefazolin were both higher than 50.0%.In addition,they were sensitive to tigecycline.The resistance rate of Pseudomonas aeruginosa to various antimicrobial agents was below 12.0%.We did not detect any resistance to linezolid,vancomycin and tigecycline in Gram-positive bacteria(G^+).【Conclusion】There are a variety of types of pathogenic bloodstream infections in leukemia patients after chemotherapy.Gram-negative bacteria(G^-)are the main stains,which have more serious drug resistance.Linezolid,vancomycin and tigecycline can be applied to the treatment of Gram-positive bacteria(G^+)bloodstream infections.