粒细胞缺乏的恶性肿瘤患者医院感染的病原菌及耐药性分析

Pathogenic Bacteria and Drug resistance Analysis of Neutropenic Malignant tumor Patients with Hospital Infection

目的:了解粒细胞缺乏(中性粒细胞<0.5×109/L)的恶性肿瘤患者医院感染的病原菌分布及对抗生素的耐药情况,为临床抗感染治疗提供依据。方法:对湖南省人民医院血液肿瘤科、儿科2011年1月~2013年7月期间收治的粒细胞缺乏且合并医院感染的恶性肿瘤患者(包括血液系统恶性肿瘤)进行回顾性分析。结果:共检测出114株病原菌,其中G-杆菌81株(71.1%),G+球菌22株(19.3%),真菌11例(9.6%)。检出菌前三位分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;耐甲氧西林葡萄球菌(MRS)8株(72.7%)。产超广谱β-内酰胺酶(ESBL)大肠埃希菌和肺炎克雷伯菌分别检出6例(21.4%)和3例(21.4%)。G-杆菌对美罗培南、亚胺培南、妥布霉素、哌拉西林/他唑巴坦、米诺环素、阿米卡星耐药率均较低(≤10%),葡萄球菌对万古霉素、替考拉宁、利奈唑胺100%敏感。真菌对5-氟胞嘧啶和两性霉素B敏感性高。结论:粒细胞缺乏的恶性肿瘤患者医院感染的病原菌大多为条件致病菌,G-杆菌占大部分。该类患者极易发生医院感染,增加病原菌送检率,根据当地及本单位的病原菌分布及耐药情况合理选用抗生素,对于该类患者的抗感染治疗有积极意义。

Objective To investigate pathogenic bacteria and drug resistance of neutropenic malignant tumor patients with hospital infection so as to provide evidences of clinical anti-infective therapy. Methods The retrospective data of neutropenic malignant tumor patients with hospital infection was analyzed of hunan province People's hospital. Results In 114 strains of pathogens isolated,gram-negtive bacteria accounted for 71. 1%, gram-positive bacteria accounted for 19. 3%,and fungi accounted for 9. 6%. The top three pathogens isolated were E. coli,K. pneumoniae and pseudomonas aeruginosa. Of the isolated pathogens,MRS( methicillin-resistant Staphylococcus aureus) was found of 72. 7% in staphylococcus,21. 4% E. coli and 21. 4% K. pneumoniae were extended-spectrum-β-lactamase( ESBL)-producing. The resistance rates in gram-negtive for Meropenem,Imipenem,Tobramycin,Piperacillin / Tazobactam,Minocycline,amikacin were all less than 10%. In this study,isolated staphylococcus was susceptible to vancomycin,teicoplanin and linezolid,and fungi was susceptible to amphotericin and 5-fluorocytosine. Conclusion The most pathogenic bacteria of neutropenic malignant tumor patients with hospital infection was conditional pathogenic bacteria,and gram-negtive bacteria were predominate. As neutropenic patients are susceptible to infection,it is significant to increase examnation of pathogen and rationally choose antibiotic based on local epidemiology of pathogen and their resistance.