2015—2019年天津医科大学肿瘤医院恶性肿瘤患者血流感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing bloodstream infections in patients with malignant tumors in Cancer Hospital of Tianjin Medical University from 2015 to 2019

目的探讨天津医科大学肿瘤医院恶性肿瘤患者血流感染病原菌分布及耐药情况,为临床合理用药提供理论依据。方法对2015—2019年天津医科大学肿瘤医院血培养结果进行回顾性分析。结果2015年1月—2019年12月天津医科大学肿瘤医院经血培养分离出菌株1471株,在科室分布方面,肝胆胰腺肿瘤科、胃肠肿瘤科、血液肿瘤科占比均超过10%;在病原菌分布方面,革兰阴性菌占67.7%;革兰阳性菌占28.1%;真菌占4.1%。革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主;革兰阳性菌中,以金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、屎肠球菌为主;在耐药性方面,碳青霉烯类、哌拉西林他唑巴坦、氟喹诺酮类、阿米卡星对主要肠杆菌科细菌保持良好的敏感性。葡萄球菌属中,表皮葡萄球菌中甲氧西林耐药菌株检出率高于金黄色葡萄球菌,表皮葡萄球菌整体耐药率高于金黄色葡萄球菌。肠球菌属中,屎肠球菌的整体耐药率高于粪肠球菌。结论天津医科大学肿瘤医院肿瘤患者血流感染的病原菌以革兰阴性菌为主,与其他肿瘤医院报道一致。耐药率低于2019年CHINET三甲医院细菌耐药监测数据。

Objective To investigate the distribution and drug resistance of pathogens causing bloodstream infections in patients with malignant tumor in Cancer Hospital of Tianjin Medical University,and to provide theoretical basis for clinical rational drug use.Methods The blood culture results of Cancer Hospital of Tianjin Medical University from 2015 to 2019 were retrospectively analyzed.Results From January 2015 to December 2019,1471 strains of bacteria were isolated by blood culture in Cancer Hospital of Tianjin Medical University.In terms of department distribution,hepatobiliary and pancreatic oncology,gastrointestinal oncology,and hematology oncology accounted for more than 10%.In terms of pathogen distribution,gram-negative bacteria accounted for 67.7%,gram-positive bacteria 28.1%,and fungi 4.1%.Gram negative bacteria were mainly Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae;gram positive bacteria were mainly Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis and Enterococcus faecium.In terms of drug resistance,carbapenems,piperacillin tazobactam,fluoroquinolones and amikacin maintained good sensitivity to the main Enterobacteriaceae.Among Staphylococcus,the detection rate of methicillin resistant Staphylococcus epidermidis was higher than that of Staphylococcus aureus,and the overall resistance rate of Staphylococcus epidermidis was higher than that of Staphylococcus aureus.The overall resistance rate of Enterococcus faecium was higher than that of Enterococcus faecalis.Conclusion Gram negative bacteria are the main pathogens of bloodstream infection in cancer patients in Cancer Hospital of Tianjin Medical University,which is consistent with other cancer hospitals.The drug resistance rate was lower than the monitoring data of bacterial resistance in the top three hospitals of Chinet in 2019.