并发院内败血症的血液病患者感染病原菌及药敏试验的情况分析

Clinical analysis of hemopathic patients with nosocomial sepsis

目的 :探讨39例并发院内败血症的血液病患者感染致病菌的情况及进行药敏试验的结果。方法 :对2008年1月至2013年12月我院血液内科收治的2427例血液病患者的临床资料进行回顾性分析,分析其并发院内败血症的情况、感染致病菌的情况及进行药敏试验的结果。结果 :在5年间我科血液病患者共有2427例患者住院,其中有39例患者并发院内败血症(占1.61%),共检出39株致病菌。在本组39例并发院内败血症的患者中,有25例(占64.1%)患者发生呼吸道感染,有7例(占17.9%)患者发生胃肠道及胆道感染。本组39例并发院内败血症的患者感染的病原菌主要为革兰阴性菌,共30株(占76.9%),其中包括大肠埃希菌9株(占23.1%),肺炎克雷伯杆菌7株(占17.9%),铜绿假单胞菌5株(占12.8%)。本组39例并发院内败血症的患者感染的革兰阳性菌共8株(占20.5%),其中包括金黄色葡萄球菌4株(占10.3%),粪场球菌2株(占5.1%),溶血葡萄球菌、藤黄微球菌各1株(各占2.6%)。本组39例并发院内败血症的患者感染的真菌共1株(占2.6%)。对G-菌最敏感的药物是碳青霉烯类抗生素(大肠杆菌、肺炎克雷伯菌、铜绿假单胞菌均对碳青霉烯类抗生素较敏感),其次为第四代头孢菌素及半合成青霉素/β-内酰胺酶抑制剂,敏感度大于65%。本组患者感染的G+菌对糖肽类抗生素无耐药,对半合成青霉素/β-内酰胺酶抑制剂及第四代头孢菌素的敏感度高于50%。常见革兰氏阴性菌对半合成青霉素类药物的敏感率不足10%,但均对亚胺培南敏感。铜绿假单胞菌对头孢唑啉、头孢曲松、复方新诺明均耐药。金黄色葡萄菌对青霉素G的耐药率100%,对糖肽类、利奈唑胺均敏感。结论 :我院血液病患者并发院内败血症所感染的病原菌以G-菌为主,其中主要的致病菌对常用抗菌药物的耐药现象严重。在为并发院内败血症的患者使用抗生素进行治疗时可首选半合成青霉素/β-内酰胺酶抑制剂,以覆盖G-菌及G+菌,也可首选碳青霉烯类及糖肽类抗生素。

Objective To investigate the pathogens, drug sensitivity distribution and clinical characteristics in hemopathic patients with nosocomial sepsis which can guide the clinical treatment. Methods A retrospectively study of pathogen distribution, drug sensitivity distribution of hemopathic patients with nosocomial sepsis in The First Affiliated Hospital of Guangdong Pharmaceutical University from 2008 January to 2013 December. Results There were 2427 person-time hospitalized in our department in 5 years,which of nosocomial septicemia in 39 cases, there were 39 strains of pathogenic bacteria.The respiratory tract is a common site of infection, followed by gastrointestinal tract.The distribution of pathogenic bacteria mainly in gram negative bacteria (76.9%),The most common gram negative bacteria was Escherichia coli(9 strains,30%),followed by Klebsiella pneumoniae (7strains,23.3%) and Pseudomonas aeruginosa (5strains,16.7%);A total of 8 strains(20.5%) of gram positive bacteria,mainly in Staphylococcus aureus (4strains,50%); 1 strains of fungi(2.6%).Drug resistance of main pathogens:Drug sensitivity: Common gram negative bacteria of semi synthetic penicillin sensitive rate of less than 10%, were sensitive to imipenem;All of Pseudomonas aeruginosa were resistant to cefazolin, ceftriaxone, cotrimoxazole.Staphylococcus aureus was penicillin-resistance,but sensitive to glycopeptide, linezolid. Conclusion Hematopathy is the risk factor of nosocomial septicemia,the mainly pathogenic bacteria of nosocomial septicemia in patients with hematopathy is G- bacteria.For high rate of drug-resistance,The rational use of antimicrobial drugs must be strengthened.