血液病患者粒细胞缺乏期革兰阴性菌血流感染的病原菌分布及药敏特点

Distribution and drug sensitivity features of pathogen of gram-negative bacterial bloodstream infection in hematological diseases patients during agranulocytosis period

目的分析血液病患者粒细胞缺乏期间发生革兰阴性菌血流感染的病原菌分布及药敏情况。方法纳入423例血液病患者,均在粒细胞缺乏期出现革兰阴性菌血流感染。按照细菌分离培养时间,将病例及其所检出病原菌分为A组(2007年1月至2012年12月)与B组(2013年1月至2018年12月)。回顾性分析患者的临床资料、病原菌分布及药敏结果。结果共分离出451株革兰阴性菌,前三位病原菌依次为大肠埃希菌(36.4%)、铜绿假单胞菌(24.0%)、肺炎克雷伯菌(20.8%)。与A组相比,B组的大肠埃希菌构成比降低,铜绿假单胞菌和肺炎克雷伯菌的构成比升高,但差异均无统计学意义(均P>0.05)。大肠埃希菌对碳青霉烯类、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和替加环素敏感性较好(耐药率均<20%),但近6年有耐替加环素菌株出现;铜绿假单胞菌对美罗培南和左氧氟沙星敏感性好(耐药率均<10%),而近6年其对亚胺培南的耐药率较前6年升高21.7%,但差异无统计学意义(P>0.05);肺炎克雷伯菌对碳青霉烯类、头孢哌酮/舒巴坦和替加环素敏感性好(耐药率均<10%)。结论血液病患者粒细胞缺乏期革兰阴性菌血流感染以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌多见,其中大肠埃希菌和肺炎克雷伯菌对碳青霉烯类药物的耐药率低,但仍需要结合致病菌流行病学和耐药监测数据特点合理使用抗生素。

Objective To analyze the distribution and drug sensitivity of the pathogens of gram-negative bacterial bloodstream infection in hematological diseases patients during agranulocytosis period.Methods A total of 423 patients with hematological diseases were enrolled,and all of them were suffered from gram-negative bacterial bloodstream infection during agranulocytosis period.The cases and the corresponding pathogens were divided into group A(between January 2007 and December 2012)and group B(between January 2013 and December 2018)according to the date of the pathogens isolation and culture.The clinical data,pathogens distribution and drug sensitivity results were analyzed retrospectively.Results Totally 451 strains of gram-negative bacteria were isolated,and the first three pathogens were Escherichia coli(36.4%),Pseudomonas aeruginosa(24.0%)and Klebsiella pneumoniae(20.8%)in sequence.Group B obtained a lower constituent ratio of Escherichia coli,and higher constituent ratios of Pseudomonas aeruginosa and Klebsiella pneumonia compared with group A,but there were no statistically significant differences(all P>0.05).Escherichia coli was moderately sensitive to carbapenems,cefoperazone/sulbactam,piperacillin/tazobactam and tigecycline(all drug resistance rates<20%),but resistant strains to tigecycline were found in the recent 6 years;Pseudomonas aeruginosa was sensitive to meropenem and levofloxacin(all drug resistance rates<10%),whereas its drug resistance rate to imipenem in the recent 6 years rose by 11.7%as compared with the rate in previous 6 years,but no statistically significant difference was observed(P>0.05);Klebsiella pneumoniae was sensitive to carbapenems,cefoperazone/sulbactam and tigecycline(all drug resistance rates<10%).Conclusion For the patients with hematological diseases,the predominant pathogens of gram-negative bacterial bloodstream infection during agranulocytosis period were Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae,among which Escherichia coli and Klebsiella pneumoniae yield a low drug-resistance rate to carbapenems;however,it is still necessary to conduct a rational use of antibiotics based on the features of pathogens epidemiology and drug resistance monitoring data.