消化道肿瘤患者血流感染革兰氏阴性菌分布和耐药情况

Distribution and drug resistance of Gram-negative bacteria in blood stream infection of patients with gastrointestinal tumors

目的分析消化道肿瘤在院治疗患者发生血流感染革兰氏阴性菌的分布和耐药情况,为临床用药及控制院内感染提供合理的指导。方法选取2019年1月到2021年12月送检的573例消化道肿瘤患者的719例次血培养阳性标本,剔除同一患者的重复菌株共654株革兰氏阴性菌,回顾性分析患者的临床特征、细菌分布及耐药变迁情况。结果革兰氏阴性菌共654株(100.0%),其中,大肠埃希菌275株(42.0%),肺炎克雷伯菌181株(27.7%),阴沟肠杆菌57株(8.7%),铜绿假单胞菌24株(3.7%),鲍曼不动菌9株(1.4%),变形杆菌5株(0.8%),其他(15.7%)。大肠埃希菌、肺炎克雷伯菌是医院检出率最高的革兰氏阴性菌,常见革兰氏阴性菌对亚胺培南、美罗培南、阿米卡星、多黏菌素、哌拉西林/他唑巴坦、氨苄西林/舒巴坦等抗菌药物敏感性较高,对头孢类抗菌药耐药性较高;产超广谱β内酰胺酶[extended-spectrumβ-lactamases(+),ESBLs(+)]大肠埃希菌、ESBLs(+)肺炎克雷伯菌未检出对亚胺培南、美罗培南、多黏菌素耐药的菌株;耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌均未检出对多黏菌素耐药的菌株。结论引起在院消化道肿瘤患者血流感染的革兰氏阴性菌出现了不同程度的耐药,临床应加强抗生素的合理使用,医院定期对血流感染病原菌进行统计分析对控制多重耐药菌的感染具有重要意义。

Objective To analyze the distribution and drug resistance of Gram-negative bacteria of bloodstream infection in patients with gastrointestinal tumors admitted to a hospital,so as to provide reasonable guidance for clinical medication and control of nosocomial infection.Method 719 positive blood culture samples from 573 patients with gastrointestinal tumors from January 2019 to December 2021 were selected.A total of 654 strains of pathogenic bacteria were removed from the same patient.The clinical characteristics,bacterial distribution and drug resistance of the patients were analyzed retrospectively.Result There were 654 strains(100.0%)of Gram-negative bacteria,including 275 strains of Escherichia coli(42.0%),181 strains of Klebsiella pneumoniae(27.7%),57 strains of Enterobacter cloacae(8.7%),24 strains of Pseudomonas aeruginosa(3.7%)and 9 strains of Acinetobacter baumannii(1.4%).Escherichia coli and Klebsiella pneumoniae were Gram-negative bacteria with the highest detection rate in hospitals.The common Gram-negative bacteria were more sensitive to imipenem,meropenem,amikacin,polymyxin,piperacillin/tazobactam,ampicillin/sulbactam,and more resistant to cephalosporins.Extended-spectrumβ-lactamases(+)[ESBLs(+)]Escherichia coli and ESBLs(+)Klebsiella pneumoniae were not resistant to imipenem,meropenem and polymyxin.Carbapenem-resistant Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Enterobacter cloacae were not found to be resistant to polymyxin.Conclusion Gram-negative bacteria causing bloodstream infection in hospitalized patients have different degrees of drug resistance,and the rational use of antibiotics should be strengthened in clinic.It is important to analyze the pathogens of bloodstream infection regularly in hospitals to control the infection of multi-drug resistant bacteria.