59例中性粒细胞缺乏伴发热的成年患者血流感染病原菌分布及药敏分析

Analysis of Pathogen Distribution and Drug Sensitivity of Bloodstream Infection in 59 Adult Patients with Neutrophil Deficiency and Fever

目的:分析我院中性粒细胞缺乏伴发热成年患者血流感染的基础疾病、原发感染部位、病原菌分布、耐药性及死亡率。方法:收集我院2017年1月1日~2019年6月30日中性粒细胞缺乏伴发热且血培养阳性的成年患者资料,进行回顾性分析。结果:共纳入59例患者,总体死亡率11.86%,罹患血液系统恶性疾病、使用免疫抑制剂、实体肿瘤的分别占88.14%、6.78%、5.08%。血流感染的原发感染部位中肺部和腹腔肠道分别占59.32%和15.25%。分离病原菌62株,革兰氏阴性杆菌、革兰氏阳性球菌分别占53.23%、27.42%。前三位病原菌分别为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌。大肠埃希菌和肺炎克雷伯菌各检出1株亚胺培南耐药的菌株。所有革兰氏阳性球菌均对万古霉素敏感。结论:中性粒细胞缺乏伴发热且血培养阳性的成年患者,病原菌构成以革兰氏阴性杆菌为主,不同细菌耐药情况不同,定期开展细菌耐药监测有助于指导临床经验性使用抗菌药物。

Objective:To investigate the basic diseases,primary infection sites,pathogen distribution,drug resistance and mortality of blood flow infection(BSI)in adult patients with neutrophilic granulocyte deficiency and fever in our hospital.Methods:Adult cases of neutrophil deficiency with fever and positive blood culture in our hospital from January 1,2017 to June 30,2019 were collected for retrospective analysis.Results:A total of 59 patients were included,with an overall mortality rate of 11.86%.Hematological malignancies,immunosuppressants and solid tumors were accounted for 88.14%,6.78% and 5.08%,respectively.The primary infection sites of BSI were lung and abdominal intestine,which were accounted for 59.32% and 15.25%,respectively.There were 62 strains of pathogenic bacteria isolated,with 53.23% for gram-negative bacilli and 27.42% for gram-positive cocci.The first three pathogens were Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa.There was one imipenem resistant strain both in Escherichia coli and Klebsiella pneumoniae.All gram-positive cocci were sensitive to vancomycin.Conclusion:In adult cases of neutrophil deficiency with fever and positive blood culture,the main pathogenic bacteria are gram-positive cocci.Owing to variety of resistance in different bacteria,regular monitoring of bacterial resistance could be helpful to guide clinical use of antibiotics.