儿童神经母细胞瘤化疗后合并血流感染的病原菌分布及耐药情况分析

Distribution and drug resistance of pathogens of blood stream infection in childhood neuroblastoma after chemotherapy

目的回顾性分析儿童神经母细胞瘤化疗后合并血流感染的病原菌种类、分布及耐药情况,为临床合理使用抗菌药物提供依据。方法收集2015年1月1日—2019年12月31日首都医科大学附属北京儿童医院血液肿瘤中心诊断神经母细胞瘤并接受化疗的病例,送检血培养阳性且排除污染和定植的标本,分析病原菌的分布和耐药情况。结果全部血流感染患儿中革兰阴性菌感染25例,占48.1%(均为革兰阴性杆菌);革兰阳性菌感染25例,占48.1%(其中革兰阳性球菌22例,革兰阳性杆菌3例);真菌感染2例,占3.8%。革兰阴性菌感染中以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌为主要致病菌;革兰阳性菌感染则主要为人葡萄球菌、表皮葡萄球菌。革兰阴性菌感染中检测到超广谱β内酰胺酶(ESBL)阳性占24%,碳青霉烯耐药革兰阴性杆菌(CRO)占40%;革兰阳性菌感染中,共检出耐甲氧西林葡萄球菌(MRS)60%。结论儿童神经母细胞瘤化疗后合并血流感染者以细菌感染为主,革兰阳性菌常见,不动杆菌感染及日益上升的凝固酶阴性葡萄球菌感染及耐药率需引起重视。

Objective This study aimed to retrospective analysis of the pathogens and the antibiotic resistance in childhood neuroblastoma complicated with bloodstream infection,provide evidence for the rational regarding antibiotic use.Methods We collected the data of pathogens and drug sensitivity test of all positive blood culture results,from all patients who was diagnosed as neuroblastoma and received chemotherapy in Beijing Children′s Hospital from January 1,2015 to December 31,2019.Bacterial strains after removal of contaminated and colonized specimens were analyzed.Results Among all the children with bloodstream infection,25 cases were Gram-negative bacteria(48.1%);25 cases were Gram-positive bacteria(48.1%)(22 cases were Gram-positive bacteria,3 cases were Gram-positive bacteria);2 cases were fungal infection(3.8%).Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae were the main pathogens in Gram-negative bacteria infection,while Staphylococcus hominis and Staphylococcus epidermidis were the main pathogens in Gram-positive bacteria infection.Positive Extended-Spectrumβ-Lactamases(ESBL)was detected 24%in gram-negative bacteria infection,and Carbapenem-resistant Organism(CRO)accounted for 40%.Among gram-positive bacterial infections,60%of methicillin-resistant staphylococcus(MRS)was detected.Conclusions Childhood neuroblastoma complicated with bloodstream infection is mainly bacterial infection.Gram-positive bacteria infection is common.We need to pay attention to acinetobacter infection and coagulase-negative staphylococcus infection,Which had the increasing infection and drug resistance rate.