河南省某三甲医院342例次造血干细胞移植术后感染病原菌分布和耐药性分析

Analysis of the distribution and drug resistance of pathogenic bacteria isolated from 342 cases of patients of infection after hematopoietic stem cell transplantation in a third grade A hospital in Henan province

目的分析造血干细胞移植术后感染特点、病原菌分布及耐药情况,为临床合理选用抗菌药物提供依据。方法回顾性分析2015年1月至2020年1月郑州大学第一附属医院342例次造血干细胞移植术后感染患者的临床资料,对感染类型、病原菌检出及耐药情况进行分析。结果342例次造血干细胞移植术后感染以血流感染为主(167例次,占48.8%),其次为肺部感染(18.4%)、皮肤软组织感染(9.4%)和胃肠道感染(8.2%)。共检出264株病原菌,其中革兰氏阴性杆菌187株(70.8%),革兰氏阳性菌59株(22.3%),真菌18株(6.9%)。革兰氏阴性杆菌以肺炎克雷伯菌(28.8%),铜绿假单胞菌(19.3%)和大肠埃希菌(11.0%)为主;革兰氏阳性菌以金黄色葡萄球菌(7.2%)和表皮葡萄球菌(6.1%)为主。肺炎克雷伯菌对亚胺培南和美罗培南耐药率分别为11.8%和13.2%,大肠埃希菌对亚胺培南和美罗培南耐药率分别为6.9%和10.3%,二者均对替加环素敏感。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为9.8%和7.8%。金黄色葡萄球菌和表皮葡萄球菌对苯唑西林耐药率分别为47.4%和87.5%,尚未发现对万古霉素、利奈唑胺耐药菌株。结论造血干细胞移植术后感染以血流感染最常见,病原菌以革兰氏阴性杆菌居多,应结合药敏结果合理选用抗菌药物,有效控制感染以提高移植成功率。

Objective To analyze the incidence of infection after hematopoietic stem cells transplantation in our hospital,so as to provide a basis for rational selection of antibacterial drugs in clinical practice.Methods The clinical data of a case of post-transplantation infection in the hematopoietic stem cell transplantation center of our hospital from January 2015 to January 2020were retrospectively analyzed,including the detection,distribution and drug resistance of strains.Results Bloodstream infection was the main infection after hematopoietic stem cell transplantation in 342 cases(48.8%),followed by pulmonary infection(18.4%),skin and soft tissue infection(9.4%)and gastrointestinal infection(8.2%).A total of 264 pathogenic bacteria were detected,including 187 strains of Gram-negative bacilli(70.8%),59 strains of gram-positive bacilli(22.3%)and 18 strains of fungi(6.9%).Gram-negative bacilli were mainly Klebsiella pneumoniae(28.8%),Pseudomonas aeruginosa(19.3%)and Escherichia coli(11.0%).The gram-positive bacteria were mainly Staphylococcus aureus(7.2%)and Staphylococcus epidermidis(6.1%).The drug resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 11.9%and 14.3%respectively,and those of Escherichia coli to imipenem and Meropenem were 6.9%and 10.3%respectively,both of which were sensitive to tegacycline.The drug resistance rates of Pseudomonas aeruginosa to imipenem and Meropenem were 9.8%and 7.8%,respectively.The drug resistance rates of Staphylococcus aureus and Staphylococcus epidermidis were 47.4%and 87.5%,respectively.Strains resistant to vancomycin and linezolid have not been found.Conclusions Bloodstream infection is the most common infection after hematopoietic stem cell transplantation in our hospital.Gram-negative bacillus was the main pathogen.Antibacterial drugs should be reasonably selected in combination with drug sensitivity results,and infection should be effectively controlled to improve the success rate of transplantation.