某院血液病患者肺炎克雷伯菌和大肠埃希菌在医院感染与社区感染中的分布及其耐药性分析

Analysis of Distribution and Resistance of KP and EC in Patients with Hematological Disease Accompanied with Hospital-acquired and Community-acquired Infection

目的:分析血液病患者肺炎克雷伯菌(Klebsiella pneumoniae,KP)和大肠埃希菌(Escherichia coli,EC)医院感染与社区感染病原菌感染部位的分布及其耐药变迁特点。方法:抽取医院2015年1月—2019年10月血液科收治的感染患者576例病历资料,比较与分析送检标本中KP和EC医院感染与社区感染感染部位的分布和耐药性差异,以及两种细菌医院感染在不同时期的耐药性变迁。结果:576例感染患者中,KP医院感染以血流感染为主148例(59.92%),社区感染多为下呼吸道感染32例(68.09%);EC以血流感染为主(分别占81.15%和45.45%);药敏结果发现在医院与社区感染中这2种病原菌对常用抗菌药物的耐药率之间的差异均无统计学意义(P>0.05),而对青霉素类和多数头孢菌素类耐药程度较为严重,但其对哌拉西林-他唑巴坦钠、头孢哌酮-舒巴坦钠的耐药率均较低(分别为14.29%~27.32%),对碳青霉烯类、替加环素和阿米卡星仍具有高度敏感;其次是对妥布霉素、头孢替坦和呋喃妥因也有较高的敏感率,此外KP对头孢他啶、头孢吡肟、左氧氟沙星耐药率均低于40.00%;KP对亚胺培南、哌拉西林-他唑巴坦钠、头孢哌酮-舒巴坦钠的耐药率由3.01%、17.16%和16.42%上升至23.33%,50.00%和35.59%;而EC对妥布霉素耐药率由45.45%下降到20.93%;医院感染中对碳青霉烯类耐药的肺炎克雷伯菌和大肠埃希菌的耐药程度较为严重,但对替加环素和阿米卡星的耐药率是在0.00%~41.67%范围内。结论:血液病患者KP和EC医院感染与社区感染以血流感染和下呼吸道感染为主,但医院感染组这2种细菌在不同时期的耐药率有一定差异,临床应加强对这2种病原菌医院感染与社区感染分布和耐药监测,促进科学合理用药,有效控制感染以减缓耐药菌的过快增长和传播。

Objective:To analyze the distribution of infection sites and drug resistance of Klebsiella pneumoniae(KP)and Escherichia coli(EC)in patients with hematopathy accompanied with hospital-acquired and communityacquired infection.Methods:The medical records of 576 infected patients admitted to the hematology Department of the hospital from January 2015 to October 2019 were selected to compare and analyze the distribution of infection sites and drug resistance differences between KP and EC hospital-acquired infection and community-acquired infection,as well as the changes of drug resistance of the two kinds of bacteria in different time periods.Results:In the 576 patients with KP infection,148 cases(59.92%)were hospital-acquired infection with bloodstream infection,while 32 cases(68.09%)were community-acquired infection with lower respiratory tract infection.EC was mainly caused by bloodstream infection(81.15%and 45.45%,respectively).Drug sensitivity results showed that there was no statistical significance in the drug resistance rates of these two pathogens to commonly used antibaterials in hospital and communityacquired infections(P>0.05),but the drug resistance to penicillins and most cephalosporins was more serious.However,the drug resistance rates of piperacillin-tazobactam and cefoperazone sulbactam were low(between 14.29%and 27.32%),and they were still highly sensitive to carbapenems,tigecycline and amikacin.Moreover,the drug resistance rates of KP to ceftazidime,cefepime and levofloxacin were all lower than 40.00%.The drug resistance rates of KP to imipenem,piperacillin-tazobactam and cefoperazone-sulbactam increased from 3.01%,17.16%and 16.42%to 23.33%,50.00%and 35.59%.The resistance rate of EC to tobramycin decreased from 45.45%to 20.93%.The degree of drug resistance to carbapenem-resistant KP and EC in hospital-acquired infections was more serious,but the drug resistance rates to tigecycline and amikacin ranged were between 0.00%and 41.67%.Conclusion:KP and EC hospital-acquired and community-acquired infection in patients with hematopathy are mainly bloodstream infection and lower respiratory tract infection,but the drug resistance rate of these two bacteria in the hospital-acquired infection group is different in different time periods.Clinical monitoring of the distribution and drug resistance of these two pathogens should be strengthened so as to promote rational drug use and control the infections and spread of drug-resistant bacteria.