血液病伴粒细胞缺乏患者临床分离菌的分布及耐药性分析

Distribution and drug resistance of analysis on clinical isolates in neutropenic patients with hematological disease

目的探讨血液病伴粒细胞缺乏患者临床分离菌的分布特点,并对其耐药性进行分析,为临床经验性抗感染治疗提供依据。方法对2015年1月至2019年6月期间就诊住院遵义医科大学附属医院血液科粒细胞缺乏及非粒细胞缺乏患者临床分离菌株进行分析,对其标本来源、细菌种类及其对常用抗菌药物的耐药性进行比较。结果来自血液内科送检的粒缺和非粒缺临床标本中分别培养出174株和209株细菌。粒缺患者血液标本的比例显著高于非粒缺患者(P<0.05)。粒缺患者中肺炎克雷伯氏菌比例显著高于非粒缺患者(P=0.002),粒缺患者中耐碳青霉烯类大肠埃希氏菌(CRE)的检出率显著高于非粒缺患者(P=0.030)。粒缺患者临床标本分离细菌以革兰氏阴性菌为主,常见菌为大肠埃希氏菌、肺炎克雷伯氏菌和铜绿假单胞菌,对碳青霉烯和加酶抑制剂的复合制剂保持较高的敏感性。结论粒缺患者经验性抗感染治疗方案应结合当地的病原菌分布及耐药特点来选择。

Objective To investigate the distribution characteristics of clinical isolates in neutropenic patients with hematologic disease and further analyze their drug resistance to provide the basis to assist clinicians in optimizing anti-infective treatment regimens.Methods Analysis of clinical isolates from patients with neutropenic and non-neutropenic at the Department of Hematopathy in the Affiliated Hospital of Zunyi Medical University between January,2015 and June,2019,and the source of their specimens,types of bacteria and their resistance to commonly used antibacterial drugs were compared.Results A total of 174 and 209 strains of bacteria was cultured from the neutropenic and non-neutropenic clinical specimens.The proportion of blood samples of patients with neutropenic was significantly higher than that in patients with non-neutropenic.The proportion of Klebsiella pneumoniae in patients with neutropenic was significantly higher than that in patients with non-neutropenic.The detection rate of carbapene-resistant Escherichia coli(CRE)in patients with neutropenic was significantly higher than that in patients with non-neutropenic.The common bacteria were Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,which maintained high sensitivity to carbapenems and compound preparations with enzyme inhibitors.Conclusion The empirical anti-infection treatment plan for patients with neutropenic should be selected according to the local pathogen distribution and the characteristics of drug resistance.