血液病粒细胞缺乏症患者医院感染病原菌的分布及药敏分析

Distribution and Drug Sensitivity of Pathogens Causing Nosocomial Infection in Patients with Hematological Granulocytosis

目的:探讨血液病粒细胞缺乏症患者医院感染病原菌的分布及药敏情况,为临床合理使用抗菌药物提供依据。方法:收集2015年5月-2018年5月兰州大学第一医院血液科发生医院感染的504例次血液病粒细胞缺乏症住院患者的病原学资料,对临床分离病原菌的分布及药敏结果进行回顾性分析。结果:共分离病原菌184株,其中168株(91.30%)来自急性白血病患者,16株(8.7%)来源于非急性白血病患者;阳性标本主要来源于血流,分离菌81株(44.00%),其次为痰和咽拭子,分别为54株(29.30%)和35株(19.00%);病原菌中革兰阴性菌126株占68.48%,最常见的为肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌,革兰阳性菌23株占12.50%,以金黄色葡萄球菌及表皮葡萄球菌为主;真菌35株占19.02%,以白假丝酵母菌为主。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌检出率分别为40.0%和22.2%,均对阿米卡星100%敏感,对碳青霉烯类抗菌素的耐药率达27.8%;肺炎克雷伯菌对阿米卡星的敏感率最高,达94.44%,对氨苄西林的耐药率达97.22%;大肠埃希菌对碳青霉烯类100%敏感,对氨苄西林耐药率最高,达80%;铜绿假单胞菌对所检测抗菌药物的敏感率均在80%以上。革兰阳性菌中检出耐甲氧西林的金黄色葡萄球菌及耐甲氧西林的凝固酶阴性葡萄球菌各1株。主要革兰阳性菌对万古霉素、利奈唑胺的敏感率达100%,对青霉素100%耐药。结论:血液病粒细胞缺乏症患者医院感染的病原菌以革兰阴性菌为主,病原菌对抗菌药物有不同耐药性,掌握常见病原菌的分布及药敏情况,对合理选择抗菌药物,控制医院感染起着重要作用。

Objective:To investigate the distribution and drug resistance of nosocomial infection pathogens in AL patients with hematological agranulocytosis,so as to provide evidence for the clinical rational use of antibiotics.Methods:Pathogenic data of 504 hospitalized patients with agranulocytosis caused by nosocomial infection in the Department of Hematology,the First Hospital of Lanzhou University from May 2015 to May 2018 were collected and retrospectively analyzed for the distribution of pathogenic bacteria and the results of drug susceptibility.Results:The isolated pathogenic bacteria strains amounted to 184,out of which,168 strains(91.3%)orginated from the patients with acute leukemia,while 16 strains(8.7%)originated from the patients with non-acute leukemia.The positive samples mainly originated from blood stream,the isolated bacteria from which were 81 straims(44%);then originated from sputam and pharynx swabs,from which isolated bacteria amounted to 54 strains(29.3%)and 35 strains(19%)respectively.In the pathogenic bacteria,the Gram-negative bacteria amounted to 126 strains accounting for 68.46%,out of which the most commond bacteria strains were Klebseilla pneumoniae,cscherichia coli and Pseudomonas aeruginosa;the Gram positive bocteria amounted to 23 strains accounting for 12.5%,mainly staphy lococeus anreus,and Staphylococcus epitermidis;the fungi amounted to 35 strains accounting for 19.02%,mainly Candida albicans.The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrumβ-lactamases(ESBLs)were 40.0%and 22.2%,respectively.They were 100%sensitive to amikacin and 27.8%resistant to carbapenems.Klebsiella pneumoniae had the highest sensitivity to amikacin,94.44%to ampicillin,97.22%to carbapenems and 100%sensitive to ammonia.Their penicillin-resistance rate was the highest,up to 80%;Pseudomonas aeruginosa was sensitive to the antibiotics(>80%).Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were detected in Gram-positive bacteria.The susceptibility rate of main Gram-positive bacteria to vancomycin and linezolid was 100%,and they were 100%resistant to penicillin.Conclusion:Gram-negative bacteria are the main pathogens of nosocomial infection in patients with hematological agranulocytosis.Pathogens have different resistance to antimicrobial agents.It is important to know the distribution and susceptibility of common pathogens for rational selection of antimicrobial agents and control of nosocomial infection.