血液恶性肿瘤患者化疗后血流感染病原菌及其耐药性

Clinical pathogen profile of bloodstream infection in patients with hematological malignancies after chemotherapy

目的分析血液恶性肿瘤化疗后血流感染(BSI)病原菌与耐药性,指导临床经验性抗感染治疗。方法回顾性分析西安交通大学医学院第二附属医院2017年1月1日-2019年12月31日98例血液恶性肿瘤化疗后BSI住院患者的临床和病原学资料,分析血液恶性肿瘤患者化疗后BSI病原菌与耐药性。结果98例血液恶性肿瘤患者化疗后BSI中革兰阴性菌72株(73.47%),革兰阳性菌23株(23.47%),真菌3株(3.06%)。病原菌以肠杆菌科细菌为主,常见病原菌依次是大肠埃希菌(40.82%)、肺炎克雷伯菌(15.31%)、铜绿假单胞菌(8.16%)、凝固酶阴性葡萄球菌(9.18%)。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类敏感率分别为95.00%和66.67%。不发酵革兰阴性杆菌中,铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为37.50%和25.00%。鲍氏不动杆菌对替加环素和甲氧苄啶/磺胺甲噁唑的敏感率均为100.00%,对其他测试药物的耐药率均>50.00%。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为66.67%和75.00%,未检出对万古霉素和利奈唑胺耐药的葡萄球菌属。链球菌对青霉素、利奈唑胺和万古霉素均敏感。热带假丝酵母对常见四种抗真菌药物均敏感。结论血液恶性肿瘤患者化疗后合并BSI病原菌以肠杆菌为主。加强血液恶性肿瘤患者化疗后BSI的病原菌耐药性监测,合理使用抗菌药物,对减少细菌耐药性,有效控制医院感染至关重要。

OBJECTIVE To understand the pathogen characteristics of bloodstream infection(BSI)in patients with hematological malignancies after chemotherapy in the Second Affiliated hospital of Xi’an jiaotong university,in order to give some reference for the empirical antimicrobial therapy.METHODS The clinical and laboratory findings in 98 BSI cases with hematological malignancies after chemotherapy in the Second Affiliated hospital of Xi’an jiaotong university from 2017 to 2019 were retrospectively analyzed.RESULTS A total of 98 cases of blood culture were positive bacterial strains,including 72(73.47%)Gram-negative bacteria(G-bacteria)strains,23(23.47%)Gram-positive bacteria(G+bacteria)strains and 3 strains(3.06%)of fungi.The main pathogens were Enterobucteriaceae and the common pathogens included Escherichia coli(40.82%),Klebsiella pneumoniae(15.31%),Pseudomonas aeruginosa(8.16%)and coagulase-negative Staphylococcus(9.18%).The sensitivities of E.coli and K.pneumoniae to carbapenems were 95.00%and 66.67%,respectively.The percentages of P.aeruginosa resistant to imipenem and meropenem were 37.50%and 25.00%,respectively.The sensitivity rate of A.baumannii to tegacycline and trimethoprim-sulfamethoxazole was 100.00%,and the resistance rate to other drugs was more than 50.00%.The detectable rate of MRCNS and MRSA was 66.67%and 75.00%,respectively,and no strains of Staphylococcus were found resistant to vancomycin or linezolid.Streptococcus strains were sensitive to penicillin,linezolid and vancomycin.Tropical Candida strains were sensitive to four common antifungal drugs.CONCLUSION The main pathogen in the blood stream infection after chemotherapy were Enterobacteriaceae strains.Strengthening the monitoring of drug resistance of bloodstream infection after chemotherapy in patients with hematological malignancies and rational use of antibacterial drugs are essential for reducing bacterial resistance and nosocomial infections could be effectively controlled.