2017-2020年血液病患者血流感染病原菌分布及耐药性分析

A Distribution and Resistance Analysis of Pathogens of Blood FlowInfection in Hematpatients During 2017-2020

目的探讨2017~2020年血液病患者血流感染的病原菌分布及耐药情况,为临床合理使用抗菌药物提供参考。方法回顾性分析2017年1月至2020年12月发生血流感染的血液病患者病原菌分布及药物敏感性情况。结果发生血流感染的306例患者共分离出病原菌347株,其中革兰阴性杆菌214株(61.7%),革兰阳性球菌106株(30.5%),真菌27株(7.8%)。革兰阴性杆菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主,革兰阳性球菌以凝固酶阴性葡萄球菌为主,真菌以热带念珠菌为主。肠杆菌科细菌对碳青霉烯类、替加环素、阿米卡星的敏感性较好>90.7%。铜绿假单胞菌对阿米卡星、头孢吡肟、头孢他啶、喹诺酮类、哌拉西林他唑巴坦的敏感性较高>91.7%,高于碳青霉烯类。主要革兰阳性球菌对替考拉宁、万古霉素、利奈唑胺、替加环素的敏感性好,发现一株粪肠球菌对利奈唑胺耐药。热带念珠菌对唑类耐药率高>30%,对其他抗真菌药物敏感性均较好。结论血液病患者血流感染病原菌的种类较多,以革兰阴性杆菌为主,不同的病原菌对抗菌药物的敏感性不同,应根据本地区本病种血流感染的病原菌分布及耐药情况合理使用抗菌药物。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in bloodstream infection of patients with blood diseases during 2017-2020,and to provide references for rational use of antibiotics in clinical practice.Methods The distribution and drug sensitivity of pathogens in patients with bloodstream infection from January,2017 to December,2020 were retrospectively analyzed.Results A total of 347 strains of pathogenic bacteria were isolated from 306 patients with bloodstream infection,including 214 strains of Gram-negative bacilli(61.7%),106 strains of Gram-positive cocci(30.5%)and 27 strains of fungi(7.8%).Gram-negative bacilli were mainly Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,while Gram-positive cocci were mainly coagulase negative staphylococci,and fungi were mainly Candida tropicalis.The sensitivity of Enterobacteriaceae to carbapenems,tigecycline and amikacin was higher than 90.7%.The sensitivity of Pseudomonas aeruginosa to amikacin,cefepime,ceftazidime,quinolones and piperacillin tazobactam was higher than that of carbapenems(>91.7%).The main Gram-positive cocci were sensitive to teicoplanin,vancomycin,linezolid and tigecycline.One strain of Enterococcus faecalis was resistant to linezolid.Candida tropicalis was more than 30%resistant to azoles,and it was sensitive to other antifungal drugs.Conclusion There are many types of pathogens causing bloodstream infections in patients with hematological diseases,mainly Gram-negative bacilli.Different pathogens have different sensitivities to antibiotics.Therefore,antibiotics should be used reasonably according to the distribution and drug resistance of pathogens causing bloodstream infections in this region.