医院血液科感染患者病原菌分布、耐药性分析及危险因素分析

Distribution, drug resistance, and risk factors for pathogens in patients with an infection in Hematology at this Hospital

目的分析医院血液科感染患者的病原菌分布和耐药性,并探讨发生感染的危险因素。方法选取2013年2月至2018年12月在本院血液科感染患者1182例,采集分泌物、痰(唾)液、尿液、血液等标本,进行病原学和耐药性检测;收集患者临床资料,采用χ~2检验分析感染发生的相关因素。结果 1182例感染患者共分离出病原菌1 305株,其中分离自分泌物标本占25.0%、分离自痰(唾液)、尿液、血液及脓肿标本分别占24.1%、21.5%、12.0%和9.6%。在1305株病原菌中,G-菌826株,占63.3%;G^+菌334株,占25.6%;真菌145株,占11.1%。G^-菌中检出率较高的是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,3种菌对氨苄西林舒巴坦、氨曲南、复方新诺明、头孢唑林、头孢呋辛钠的耐药率较高(16.58%~100%),对阿米卡星、厄它培南、美洛培南、哌拉西林/他唑巴坦、妥布霉素的耐药率较低(0~9.41%)。G^+菌中检出率较高的是金黄色葡萄球菌和肺炎链球菌,2种菌对阿奇霉素、克林霉素、四环素的耐药率较高(22.22%~100%),对利福平、利奈唑烷、莫西沙星、万古霉素的耐药率较低(0~8.89%)。经单因素分析,年龄、病程、侵入性操作是血液科患者发生感染的相关因素(P<0.05)。结论血液科患者感染的致病病原菌种类广泛且对部分抗菌药物的耐药性较高;感染的发生与患者年龄、病程、侵入性操作等因素有关,可供临床医师参考。

Objectives To analyze the distribution and drug resistance of pathogens in patients with an infection in Hematology at this Hospital and to explore the risk factors for infection. Methods Subjects were 1,182 patients with an infection in Hematology at this Hospital from February 2013 to November 2018. Samples of secretions, sputum(saliva), urine, and blood were collected. The etiology of infections and drug resistance of pathogens causing them were analyzed, and a single factor chi-square test was used to analyze the risk factors for infection. Results A total of 1,305 strains of pathogens were isolated from 1,182 patients with an infection. Twenty-five percent of those strains were isolated from secretion specimens, 24.1% were isolated from sputum and saliva specimens, 21.5% were isolated from urine specimens, 12.0% were isolated from blood specimens, and 9.6% were isolated from abscess specimens. Of the 1,305 strains of pathogens, 826(63.3%) were strains of Gram-negative bacteria, 334(25.6%) were strains of Gram-positive bacteria, and 145(11.1%) were strains of fungi. The Gram-negative bacteria detected were often Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. These three bacteria were highly resistant(16.58-100%) to ampicillin sulbactam, aztreonam, compound trimethoprim, cefazolin, and cefuroxime sodium and least resistant(0-9.41%) to amikacin, ertapenem, meropenem, piperacillin/tazobactam, and tobramycin. The Gram-positive bacteria detected most often were Staphylococcus aureus and Streptococcus pneumoniae. These two bacteria were highly resistant(22.22-100%) to azithromycin, clindamycin, and tetracycline and least resistant(0-8.89%) to rifampicin, linezolid, moxifloxacin, and vancomycin. Univariate analysis indicated that age, course of disease, and invasive surgery were risk factors for infection in patients in Hematology(P<0.05). Conclusion A wide range of pathogens caused an infection in patients in Hematology, and those pathogens were resistant to some antibiotics. The development of an infection was closely related to factors such as age, course of disease, and invasive surgery. These findings can serve as a reference for clinicians.