广谱β-内酰胺酶在恶性血液病感染中的临床研究

Clinical analysis of extended spectrum β-lactamase producing bacteria' s infection in hematologic malignancies

目的:分析恶性血液病患者产超广谱β-内酰胺酶(ESBLs)菌感染的临床特点和对策;方法:收集我院血液科2000年1月～2002年12月ESBLs(+)菌株引起的感染46例;随机抽取45例ESBLs(-)菌感染者作为对照进行总结分析。结果:产生ESBLs主要为G-杆菌,以肺炎克雷伯杆菌、大肠杆菌最为常见;住院时间长,中性粒细胞缺乏,免疫功能下降和第三代头孢菌素使用时间超过7天者为ESBLs菌株感染的高危因素(P<0.05);ESBLs(+)组中以败血症和肺部感染为最主要的感染形式;所有的ESBLs菌对亚胺培南敏感,阿米卡星和哌拉西林—他唑巴坦复合制剂具有一定的抗菌活性,对第三代头孢菌素耐药。结论:ESBLs菌的产生有其高危因素,诊断明确后及时选用敏感抗生素,可以改善预后。

Objective To analysis the clinical characteristics of extended of spectrumβ-lactamase(ESBLs )producing bacteria' s infection in hematologic malignan cies.Methods The data of 46cases of ESBLs (+)bacterias in500hematologic malignancies' infections fromJanuary 2000to November 2002in the Department of Hemato logy in An Hui Provincial Hospital were analysised;45cases of ESBLs (-)infection were randomly selected as control.Results ESBLs producing bacterias were almo stly Gramstain negative ones,especially Klebsiellae pneumonia and Esc herichia coli.Long time hospitalization,agranulocytosis,defects in humoral a nd cell -mediated immunity,use of th e third generation cephalosporins >7days were risk factors for ESBLs (+)pathogen infection(P<0.05).Sepsis and lung infection were often seen;All ESBLs (+)bacterias were sensitive to Imipenem,Amikacin and Piperacillin -sulbac-tam have some activities to ESBLs (+)bacterias,but the third generation cephalosporins were often resistan ce.Conclusions ESBLs has high risk factors to origin ate ,and the outcome would be improved if sensitive antibiotics were choosen as soon as the diagnosis was m ade.