血液病患者血流感染病原菌耐药性与病死影响因素分析

Analysis of drug resistance and influencing factors of bloodstream infection pathogens in patients with hematopathy

目的探究血液病血流感染患者的病原菌分布与耐药性情况,并对其预后病死的影响因素进行分析。方法选取2017年4月-2018年4月海南西部中心医院收治的血液病血流感染患者143例为研究对象,在血流感染30 d内死亡28例,设为死亡组,剩余115例设为存活组。比较143例血液病血流感染患者的病原菌和耐药性;归纳血液病血流感染患者预后病死的影响因素。结果本研究共培养分离病原菌156株,其中51株(32.69%)为革兰阳性菌,主要为金黄色葡萄球菌和表皮葡萄球菌;革兰阴性菌98株占62.82%,以肺炎克雷伯菌、大肠埃希菌和鲍氏不动杆菌为主;真菌7株占4.49%。金黄色葡萄球菌和表皮葡萄球菌对青霉素的耐药率均最高,分别为86.67%和100.00%;肺炎克雷伯菌和大肠埃希菌对美罗培南的耐药率最低,鲍氏不动杆菌对各种抗菌药物的耐药率均较高;年龄、感染性休克和血小板是血液病血流感染患者预后病死的影响因素(P<0.05)。结论血液病血流感染患者以革兰阴性菌居多,其中金黄色葡萄球菌和表皮葡萄球菌对青霉素的耐药率最高,肺炎克雷伯菌对美罗培南的耐药性最低,这为今后在治疗过程中对抗菌药物的合理选择提供依据。

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria in patients with bloodstream infection of hematological diseases, and to analyze the influencing factors of their prognosis and death. METHODS From Apr. 2017 to Apr. 2018, a total of 143 patients with bloodstream infections of hematological diseases treated in the Western Central Hospital of Hainan were selected as the research subjects. 28 patients died within 30 days of the bloodstream infection and were classified as death groups. The remaining 115 were set alive group. The pathogenic bacteria and drug resistance of 143 patients with bloodstream infections were compared and the factors influencing the prognosis of patients with bloodstream infections were summarized. RESULTS In this study, 156 strains of pathogenic bacteria were isolated, of which 51 strains(32.69%) were gram-positive, mainly Staphylococcus aureus and Staphylococcus epidermidis;98 strains of Gram-negative bacteria accounted for 62.82%, mainly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii;7 strains of fungi accounted for 4.49%. S. aureus and S. epidermidis strains have the highest resistance rates to penicillin, 86.67% and 100.00%, respectively;K. pneumoniae strains and E. coli had the lowest resistance rates to meropenem, and A. baumannia immobilis had a high resistance rate to various antibacterial drugs. Age, septic shock and platelets were the influencing factors for the prognosis of patients with bloodstream infection due to blood diseases(P<0.05). CONCLUSION The majority of patients with bloodstream infections of hematological diseases is Gram-negative bacteria, of which S. aureus and Staphylococcus epidermidis strains had the highest resistance to penicillin, and Klebsiella pneumoniae strains had the lowest resistance to meropenem, which provides a basis for the rational selection of antibacterial drugs during treatment.