血液病患者细菌性血流感染病原菌分布及耐药特点单中心数据分析

A single-center analysis of pathogenic bacteria distribution and drug resistance in bacterial bloodstream infections among patients with hematological diseases

目的分析血液病患者细菌性血流感染的病原菌分布和耐药情况, 为临床经验性抗感染治疗提供病原学数据依据。方法对天津医科大学总医院血液科2016年1月至2022年12月经血培养确诊为细菌性血流感染的血液病患者的一般临床信息、病原菌及药物敏感试验结果进行回顾性分析。结果共纳入498例细菌性血流感染患者, 共发生619例次感染, 分离出639株细菌。其中86.9%为恶性血液病患者, 76.7%处于粒细胞缺乏期, 65.9%存在导管留置, 32.6%出现降钙素原升高, 10.7%发生血流动力学改变。常见感染部位为呼吸道(60.6%)、口腔黏膜及皮肤软组织(17.3%)、腹腔(14.5%)。639株细菌中革兰阴性(G-)菌占79.0%, 革兰阳性(G+)菌占21.0%, 前5位病原菌依次为肺炎克雷伯菌(22.5%)、大肠埃希菌(20.8%)、铜绿假单胞菌(15.0%)、屎肠球菌(5.5%)、嗜麦芽窄食单胞菌(5.0%)。G+球菌检出率在2020-2022年呈上升趋势。肺炎克雷伯菌对喹诺酮类和头孢菌素类药物的耐药率在2016-2018年间有所上升, 但在2019年后呈下降趋势。铜绿假单胞菌对碳青霉烯类药物的耐药率约为20.0%, 2019年耐药率峰值为35.7%。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)对甲氧西林的耐药率为60.0%, 检测到1例耐利奈唑胺的MRCNS。结论本中心细菌性血流感染以G-杆菌为主, 但G+球菌在2020-2022年呈上升趋势, 应警惕碳青霉烯类耐药铜绿假单胞菌和肺炎克雷伯菌。

Objective To analyze the distribution and drug resistance of pathogens of bacterial bloodstream infection in patients with hematological diseases in the Department of Hematology of Tianjin Medical University General Hospital,and to provide etiological data for clinical empirical anti-infection treatment.Methods A retrospective analysis was conducted on the general clinical information,pathogenic bacteria and drug susceptibility test results of patients with hematological diseases diagnosed with bacterial bloodstream infection by menstrual blood culture in our center from January 2016 to December 2022.Results Patients included 498 inpatients,with a total of 639 bacterial strains.Among the patients,86.9%patients had malignancies,and 76.7%had agranulocytosis.Symptoms of concurrent infections,including those of the respiratory tract,oral mucosa,skin and soft tissues,and abdominal sources were observed in 68.3%patients.Gram-negative bacteria(G)accounted for 79.0%of the isolated bacteria,and gram-positive bacteria (G') accounted for 21.0%. The top five isolated pathogens were Klebsiellapneumoniae (22.5%), Escherichia coli(20.8%), Pseudomonas aeruginosa (15.0%), Enterococcus faecium(5.5%), and Stenotrophomonas maltophilum (5.0%). Escherichia coli exhibited a decreasing trend ofresistance to quinolones, cephalosporins, and carbapenems. Klebsiella pneumoniae exhibited increasingrates of resistance to quinolones and cephalosporins between 2016 and 2018, but the rated decreased after2019. The resistance rate to carbapenems exhibited by Pseudomonas aeruginosa was approximately 20%.Carbapenem-resistant strains of Pseudomonas aeruginosa strains were first detected in 2017, with a peakresistance rate of 35.7%, detected in 2019. A 60.0% resistance rate to methicillin was observed inmethicillin-resistant coagulase-negative staphylococci (MRCNS), and one case of linezolid-resistantMRCNS was detected. Conclusions Pathogenic bacteria of bacterial bloodstream infections were widelydistributed in our center, and precautions are warranted against carbapenem resistant P. aeruginosa andKlebsiella pneumoniae.