恶性血液病患者血流感染的病原菌分布及耐药性单中心回顾性分析

A single-center study on the distribution and antibiotic resistance of pathogens causing bloodstream infection in patients with hematological malignancies

目的探讨恶性血液病患者血流感染的发生率、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2018年1月至2021年12月南方医科大学南方医院血液科收治的恶性血液病合并血流感染患者的临床资料、病原菌分布及耐药性情况。结果4年内22717例次患者共发生582次血流感染,2018-2021年血流感染的发生率依次为2.79%、2.99%、2.79%和2.02%。共分离出599株病原菌,革兰阴性菌487株(81.3%),主要为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌;革兰阳性菌81株(13.5%),主要为金黄色葡萄球菌、表皮葡糖球菌和屎肠球菌;真菌31株(5.2%),以热带念珠菌为主。主要肠杆菌科细菌对碳青霉烯类、哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和替加环素的耐药率分别为11.0%、15.3%、15.4%和3.3%。主要非发酵菌对哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和喹诺酮类抗菌药物耐药率分别为29.6%、13.3%和21.7%。81株革兰阳性菌中仅2例对糖肽类抗菌药物耐药。结论2018-2021年南方医科大学南方医院血液科恶性血液病患者血流感染以革兰阴性菌为主,不同菌种耐药率差异较大。

Objective To study the incidence of bloodstream infections,pathogen distribution,and antibiotic resistance profile in patients with hematological malignancies.MethodsFrom January 2018 to December 2021,we retrospectively analyzed the clinical characteristics,pathogen distribution,and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology,Nanfang Hospital,Southern Medical University.ResultsA total of 582 incidences of bloodstream infections occurred in 22,717 inpatients.From 2018 to 2021,the incidence rates of bloodstream infections were 2.79%,2.99%,2.79%,and 2.02%,respectively.Five hundred ninety-nine types of bacteria were recovered from blood cultures,with 487(81.3%)gram-negative bacteria,such as Klebsiella pneumonia,Escherichia coli,and Pseudomonas aeruginosa.Eighty-one(13.5%)were gram-positive bacteria,primarily Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus faecium,whereas the remaining 31(5.2%)were fungi.Enterobacteriaceae resistance to carbapenems,piperacillin/tazobactam,cefoperazone sodium/sulbactam,and tigecycline were 11.0%,15.3%,15.4%,and 3.3%,with a descending trend year on year.Non-fermenters tolerated piperacillin/tazobactam,cefoperazone sodium/sulbactam,and quinolones at 29.6%,13.3%,and 21.7%,respectively.However,only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics.ConclusionsBloodstream pathogens in hematological malignancies were broadly dispersed,most of which were gram-negative bacteria.Antibiotic resistance rates vary greatly between species.Our research serves as a valuable resource for the selection of empirical antibiotics.