血液恶性肿瘤并发重症肺部感染患者病原菌检出特点及耐药性分析

Analysis of Pathogenic Bacteria Detection Characteristics and Drug Resistance in Patients with Hematological Malignant Tumors Complicated with Severe Pulmonary Infection

目的:探究血液恶性肿瘤并发重症肺部感染患者病原菌分布特征与耐药性。方法:前瞻性选取2019年10月—2022年10月晋江市医院收治的209例血液恶性肿瘤并发重症肺部感染患者,采集其痰液行细菌培养与药敏试验,探究209例患者的病原菌检出情况、耐药性。结果:209例血液恶性肿瘤并发重症肺部感染患者总计分离出病原菌218株,其中革兰阴性菌检出116株,占比53.21%(116/218);以46株(21.10%)大肠埃希菌、35株(16.06%)鲍曼不动杆菌、17株(7.80%)肺炎克雷伯菌、14株(6.42%)铜绿假单胞菌多见;革兰阳性菌共检出89株,占比40.83%(89/218),以41株(18.81%)粪肠球菌、26株(11.93%)金黄色葡萄球菌、18株(8.26%)肺炎链球菌常见;真菌共检出13株,占比5.96%(13/218);主要革兰阴性菌对阿米卡星(AMK)、头孢唑林(CFZ)、头孢曲松(CRO)、氨苄西林(AM)、头孢呋辛(CXM)、氨曲南(ATM)、头孢他啶(CAZ)、环丙沙星(CIP)、复方新诺明(SMZ-TMP)、左氧氟沙星(LVX)耐药率高,对厄他培南(ETP)、庆大霉素(GEN)、妥布霉素(TOB)、亚胺培南(IPM)、头孢吡肟(FEP)、四环素(TE)、头孢哌酮(CFP)、美罗培南(MEM)耐药率低;主要革兰阳性菌对TE、CIP、庆大霉素(GM)、青霉素(PEN)、LVX、苯唑西林(OX)、AMP、克林霉素(CM)、莫西沙星(MXF)耐药率高,对呋喃妥因(NFT)、万古霉素(VAN)、利福平(RIF)、替加环素(TGC)、替考拉宁(TEC)、利奈唑胺(LNZ)耐药率低。结论:血液恶性肿瘤并发重症肺部感染患者感染的致病菌以革兰阴性菌为主,而多种病原菌的耐药性均处在较高水平,对此临床需予以高度关注。

Objective:To explore the distribution characteristics and drug resistance of pathogenic bacteria in patients with hematologic malignancies complicated with severe pulmonary infections.Method:A prospective study was conducted on 209 patients with hematological malignancies complicated with severe pulmonary infections admitted to Jinjiang Hospital from October 2019 to October 2022.Sputum samples were collected for bacterial culture and drug sensitivity testing to investigate the detection of pathogenic bacteria and drug resistance in the 209 patients.Result:A total of 218 strains of pathogenic bacteria were isolated from 209 patients with hematological malignancies complicated with severe pulmonary infections,of which 116 strains were detected as Gram negative bacteria,accounting for 53.21%(116/218);46 strains(21.10%)of Escherichia coli,35 strains(16.06%)of Acinetobacter baumannii,17 strains(7.80%)of Klebsiella pneumoniae,and 14 strains(6.42%)of Pseudomonas aeruginosa were most common;a total of 89 strains of Gram positive bacteria were detected,accounting for 40.83%(89/218),with 41 strains(18.81%)of Enterococcus faecalis,26 strains(11.93%)of Staphylococcus aureus,and 18 strains(8.26%)of Streptococcus pneumoniae being common;a total of 13 fungi were detected,accounting for 5.96%(13/218);the main Gram-negative bacteria resistance rate of Amikacin(AMK),Ceftriaxone(CFZ),Ceftriaxone(CRO),Ampicillin(AMP),Cefuroxime(CXM),Aztreonam(ATM),Ceftazidime(CAZ),Ciprofloxacin(CIP),Sulfamethoxazole-Trimethoprim(SMZ-TMP),Levofloxacin(LVX),and to Etapenem(ETP),Gentamicin(GEN),Tobramycin(TOB),Imipenem(IPM),Cefepime(FEP)were high,the resistance rates of Tetracycline(TE),Cefoperazone(CFP),and Meropenem(MEM)were low;the main Gram positive bacteria resistance rate of TE,CIP,gentamicin(GM),Penicillin(PEN),LVX,Oxacillin(OX),AMP,Clindamycin(CM),and Moxifloxacin(MXF)were high,but resistance rate of Nitrofurantoin(NFT),Vancomycin(VAN),Rifampicin(RIF),Tigecycline(TGC),Teicoplanin(TEC),and Linezolid(LNZ)were low.Conclusion:Gram negative bacteria are the main pathogens causing infections in patients with hematologic malignancies complicated by severe pulmonary infections,and the drug resistance of various pathogens is at a high level.Therefore,high attention should be paid to this in clinical practice.