深圳市罗湖区发热性中性粒细胞减少性血液病患者病原菌分布和耐药性分析

Distribution and drug resistance of pathogenic bacteria in patients with febrile neutropenic hematopathy in Luohu District of Shenzhen City

目的分析深圳市罗湖区发热性中性粒细胞减少性血液病患者病原菌分布和耐药性。方法回顾性分析2017年6月~2019年12月深圳市罗湖区305例发热性中性粒细胞减少性血液病患者的临床资料、药敏实验结果,分析病原菌分布和耐药性。结果305例血培养阳性标本,共分离出非重复的病原菌82株,其中革兰氏阴性菌61株,占74.39%,以大肠埃希菌最多,共31株(37.80%);革兰氏阳性菌18株,占21.95%,以凝固酶阴性葡萄球菌最多,共8株(9.76%);真菌3株,占3.66%。药敏实验结果显示,肺炎克雷伯菌和大肠埃希菌对β内酰胺酶类抗菌药物的耐药率在40.00%~90.00%,但大肠埃希菌和肺炎克雷伯菌对β内酰胺酶抑制剂的复合物哌拉西林/他唑巴坦的耐药率较低,分别为6.00%、11.00%;大肠埃希菌和肺炎克雷伯菌对阿米卡星的耐药率分别为25.50%、12.30%;大肠埃希菌和肺炎克雷伯菌对头孢西丁耐药率分别为38.00%、10.00%。肺炎克雷伯菌和大肠埃希菌对美洛培南、亚胺培南抗菌药物均高度敏感。铜绿假单胞菌对美洛培南、亚胺培南抗菌药物同样高度敏感,对哌拉西林/他唑巴坦、头孢吡肟、氨基糖苷类、喹诺酮类抗菌药物的耐药率为12.00%~26.00%。金黄色葡萄球菌对红霉素、苯唑西林、青霉素类抗菌药物的耐药率高达33.00%~100.00%。凝固酶阴性葡萄球菌耐药性高于金黄色葡萄球菌,达44.00%~100.00%。结论深圳市罗湖区发热性中性粒细胞减少性血液病患者病原菌分布以革兰氏阴性菌为主,对美洛培南、亚胺培南抗菌药物均高度敏感。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in patients with febrile neutropenic hematopathy in Luohu District of Shenzhen city.Methods The clinical data and drug sensitivity test results of 305 patients with febrile neutropenic hematopathy from June 2017 to December 2019 in Luohu District of Shenzhen City were retrospectively analyzed,and the distribution and drug resistance of pathogens were analyzed.Results Among the 305 cases of blood culture positive specimens,82 non-duplicative pathogenic bacteria were isolated,among which 61 were gram-negative bacteria,accounting for 74.39%,and Escherichia coli was the most,with 31 strains(37.80%).There were 18 gram-positive bacteria,accounting for 21.95%,and Coagulase-negative Staphylococcus was the most,8 strains(9.76%).There were three strains of fungus,accounting for 3.66%.The susceptibility test results showed that the resistance rates of Klebsiella pneumoniae and Escherichia coli to lactamase inhibitors were 40%-90%,but the resistance rates of Escherichia coli and Klebsiella pneumoniae toβlactamase inhibitors complex Piperacillin/Tazobactam were lower,6.00%and 11.00%,respectively.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to Amikacin were 25.50%and 12.30%respectively.The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to Cefoxitin were 38.00%and 10.00%respectively.Klebsiella pneumoniae and Escherichia coli were highly sensitive to Meropenem and Imipenem.Pseudomonas aeruginosa was also highly sensitive to Meropenem and Imipenem,and the drug resistance rate to Piperacillin/Tazobactam,Cefepime,Aminoglycosides and Quinolones was 12.00%-26.00%.The drug resistance rate of Staphylococcus aureus to Erythromycin,Oxacillin and Penicillin antibacterial drugs was as high as 33.00%-100.00%.Coagulase-negative Staphylococcus had higher drug resistance than Staphylococcus aureus,reaching 44.00%-100.00%.Conclusions Gram negative bacteria are the main pathogens of patients with febrile neutropenic hematopathy in Luohu District of Shenzhen City,and they are highly sensitive to Meropenem and Imipenem.