实体瘤患儿导管相关性血流感染的病原学及药敏分析

Etiology and drug sensitivity analysis of catheter-related bloodstream infection in children with solid tumors

目的探讨实体瘤患儿化疗后导管相关性血流感染(CRBSI)的病原菌类型及其耐药性。方法对2014年1月至2015年12月首都医科大学附属北京同仁医院非重症监护室(ICU)儿科病房住院化疗并留置外周静脉导管(PICC)及中央静脉导管(CVC)的患儿进行回顾性总结,分析其临床特点、病原菌构成和药物敏感试验结果。结果 2014年1月至2015年12月共化疗3 361例次,累计置有PICC者及CVC者3 300例次,共送检导管血培养64次,发生CRBSI 24例次,其中4例次为真菌感染,CRBSI感染率为0.7%,真菌感染率为0.12%;共分离出病原菌14株,其中革兰阴性菌3株,占21.4%;革兰阳性菌9株,占64.3%;真菌2株,占14.3%;主要病原菌中(共24例次阳性,耐药12例)耐甲氧西林凝固酶阴性葡萄球菌(3例)、耐碳青霉烯类肺炎克雷伯菌(7例)、产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(2例)检出率分别为12.5%、29.2%、8.3%;凝固酶阴性葡萄球菌对万古霉素、美罗培南、利奈唑胺的敏感率均为100%,光滑念珠菌和白色念珠菌对伏立康唑、两性霉素B和氟胞嘧啶的敏感性为100%,对氟康唑和伊曲康唑的敏感性为0。结论监测实体肿瘤患儿的CRBSI发生及病原学变化,有助于进一步加强有效的预防控制措施和提供早期的经验性抗菌药物治疗方案。

Objective To investigate the pathogen types and drug resistance of catheter-related bloodstream infection(CRBSI)in children with solid tumor after chemotherapy.Methods The clinical characteristics,pathogenic bacteria composition and drug sensitivity test results of children hospitalized with chemotherapy and indwelling periphe-ral venous catheter(PICC)and central venous catheter(CVC)in the non-Intensive Care Unit(ICU)of the Pediatric Ward of Beijing Tongren Hospital,Capital Medical University from January 2014 to December 2015 were retrospectively summarized.Results A total of 3361 cases received chemotherapy,3300 cases received PICC and CVC,and the blood cultures of 64 cases were sent for test.Twenty-four cases had CRBSI,4 of who were of fungal infection.The infection rate of CRBSI was 0.7%and the infection rate of fungi was 0.12%.A total of 14 pathogenic bacteria were isolated,including 3 strains of Gram-negative bacteria(21.4%),9 strains of Gram-positive bacteria(64.3%),and 2 strains of fungi(14.3%).The main pathogenic bacteria detected positive in 24 cases(12 cases were drug-resistant)included the methicillin-resistant coagulase-negative staphylococci(3 cases),carbapenem-resistant Klebsiella pneumoniae(7 cases)and extended spectrum beta-lactamases(ESBLs)producing Escherichia coli(2 cases),and their detection rates were 12.5%,29.2%and 8.3%,respectively.The sensitivity rate of coagulase-negative staphylococci to Vancomycin,Meropenem and Linezolid was 100%.Candida glabrata and candida 100%sensitive to Voriconazole,Amphotericin B and Flucytosine but not sensitive to Fluconazole and Itraconazole.Conclusions Monitoring the occurrence and etiological changes of CRBSI in children with solid tumors is helpful to further strengthen effective prevention and control measures and provide early empirical antimicrobial therapy.