中医院血液科血流感染病原菌分布及耐药分析

Analysis on distribution and drug resistance of bloodstream infection pathogens in hematology department of traditional Chinese medicine hospital

目的了解中医院血液病患者血流感染的临床特点、病原菌分布和耐药情况,为临床抗感染治疗提供依据。方法回顾性分析2016年1月至2018年12月湖北省中医院血液科发生血流感染患者的临床资料,包括原发疾病、病原菌种类及对常用抗菌药物的耐药情况等。结果送检血培养标本共801份,分离出病原菌220株,其中革兰阳性菌46株(20.91%),主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌和肠球菌,革兰阴性菌172株(78.18%),主要为大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌,真菌2株(0.91%),为白色念珠菌。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类抗菌药物的敏感率均为100.00%;主要革兰阳性菌对万古霉素、替考拉宁的敏感率达到100.00%,白色念珠菌对5-氟胞嘧啶100.00%敏感,24株金黄色葡萄球菌中检出耐甲氧西林金黄色葡萄球菌6株,12株凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌检出率为50.00%。结论湖北省中医院血液病住院患者血流感染病原菌中,革兰阴性菌所占比例较高,且对多种抗菌药物不同程度耐药。

Objective To understand the clinical characteristics,pathogen distribution and drug resistance of bloodstream infection in the patients with hematological diseases in the Chinese medicine hospital to provide a basis for clinical anti-infective treatment.Methods The clinical data of the patients with bloodstream infection in the hematological department of this hospital from January 2016 to December 2018 were retrospectively analyzed,including primary diseases,pathogen species and resistance to commonly used antibacterial drugs.Results A total of 801 cases of blood culture were submitted and 220 strains of pathogens were isolated,including 46 strains of Gram-positive bacteria(20.91%),mainly Staphylococcus aureus,coagulase-negative staphylococcus and enterococci;and 172 strains of Gram-negative bacteria(78.18%),mainly Escherichia coli,Klebsiella pneumoniae and Acinetobacter baumannii;2 strains of fungi(0.91%),which were Candida albicans.The sensitivity of Escherichia coli and Klebsiella pneumoniae to carbapenem antibiotics was 100.00%.The sensitivity of the main Gram-positive bacteria to vancomycin and teicoplanin reached 100.00%.Candida albicans was 100.00%sensitive to 5-fluorocytosine.Six strains of methicillin-resistant Staphylococcus aureus were detected in 24 strains of Staphylococcus aureus,and the detection rate of methicillin-resistant coagulase-negative staphylococci in 12 strains of coagulase-negative staphylococci was 50.00%.Conclusion Among the pathogens of bloodstream infections in hospitalized patients with blood diseases in the Traditional Chinese Medicine Hospitals,Gram-negative bacteria account for a high proportion and are resistant to multiple antibacterial drugs in various extents.