急性白血病患者细菌性血流感染临床和病原学分析

Clinical and Bacteriological Analysis of Bacterial Bloodstream Infections in Patients with Acute Leukemia

目的:探讨急性白血病(AL)患者细菌性血流感染的临床特点、病原学和药敏情况。方法:回顾性分析2009年4月至2018年4月发生细菌性血流感染AL患者的临床资料、病原学及药敏结果资料。结果:共353例患者发生血流感染,分离出病原菌376株。其中革兰阴性菌289株(76.9%),革兰阳性菌87株(23.1%)。革兰阴性菌中前3位依次是:大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌。大肠埃希菌对替加环素、亚胺培南及美罗培南的敏感率分别为100.0%、98.2%和98.1%,肺炎克雷伯菌对替加环素、亚胺培南及美罗培南的敏感率分别为100.0%、98.3%和94.4%。主要革兰阴性菌血流感染患者初始应用碳青霉烯类药物调整率为3.8%;初始应用非碳青霉烯类药物调整率为74.3%(P<0.05)。革兰阳性菌对糖肽类抗菌药、利奈唑胺、替加环素的敏感率为100.0%,对304(87.9%)例感染的控制均好。结论:AL患者发生细菌性血流感染的病原菌以革兰阴性菌多见。革兰阴性菌对碳青霉烯类和替加环素的敏感性均高,初始应用碳青霉烯类药物治疗调整率低。革兰阳性菌对糖肽类、利奈唑胺、替加环素均敏感。

Objective:To investigate the clinical characteristics,etiology and drug susceptibility of bacterial bloodstream infections in acute leukemia(AL)patients.Methods:Clinical data,etiology and drug susceptibility of acute leukemia patients with bacterial bloodstream infections from April 2009 to April 2018 were retrospectively analyzed.Results:A total of 376 strains were isolated,76.9%was Gram-negative bacterial and 23.1%was Gram-positive bacteria.Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were listed as the top three of Gram-negative bacteria.The susceptibility of Escherichia coli to the tigacycline,imipenem and meropenem was 100.0%,98.2%and 98.1%,respectively.The susceptibility of Klebsiella pneumoniae to the tigacycline,imipenem and meropenem were 100.0%,98.3%and 94.4%,respectively.The adjustment rate for initial use of carbopenems was 3.8%,while the adjustment rate for initial use of noncarbopenems was 74.3%in patients with main Gram-negative bacterial blood stream infection.The susceptibility of Gram-positive bacteria to glycopeptide antibiotics,linezolid and tigacycline was 100.0%.Conclusion:Gram-negative bacteria is the majority type of bacteria in AL patients with bacteria blood stream infections.The susceptibility of Gram-negative bacteria to the carbapenems is high,and the treatment adjustment rate is obviously low.The glycopeptide,linezolid and tigacy cline are effective for Gram-positive bacteria infections.