摘要
目的:了解血液科合并感染的粒缺患者致病菌的分布及耐药性特点。方法:对2005-01-2012-12上海市第一人民医院血液科粒缺及非粒缺住院患者的临床分离菌株进行分析、比较,所分离的菌株均用Kirby-Bauer法进行药敏试验,并应用WHONET 5.6软件分析病原菌及药敏数据,用STATA 7软件进行统计比较。结果:来自粒缺和非粒缺患者的临床标本中分别培养分离出355株和784株细菌,粒缺患者革兰阴性菌占70.4%,高于非粒缺患者55.0%的比例(P<0.01),其呼吸道分泌物标本所分离的革兰阴性菌中,不发酵糖革兰阴性杆菌所占比例高于非粒缺患者(52.9%∶30.5%,P<0.01),其血流标本中大肠埃希菌的比例显著高于非粒缺患者(17.6%∶6.0%,P<0.01)。粒缺患者甲氧西林耐药金黄色葡萄球菌(MRSA)及甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的检出率均已达100%。粒缺患者分离的大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率分别为57.6%和31.9%,高于非粒缺患者(P值分别<0.01和0.05)。粒缺患者分离的不发酵糖革兰阴性杆菌对碳青霉烯类药物表现出较高的耐药率,其对亚胺培南、美罗培南的耐药率分别高达42.1%和31.6%,均高于非粒缺患者(P值分别<0.01和0.05)。结论:粒缺伴感染患者经验性抗感染治疗方案应根据其致病菌分布及耐药性特点来选择。
Objective：To compare the distribution and drug resistance of pathogenic bacteria between neutro- penic and non-neutropenic patients with hematological disease in the same period. Method：A total of 355 and 784 bacterial strains were isolated from neutropenic and non-neutropenic patients from January 2000 to December 2012. Antimicrobial susceptibility testing was done by Kirby-Bauer method and the results were analyzed according to CLSI 2014 breakpoints. Result： The clinical specimens came from neutropenic patients and non-neutropenic pa- tients respectively cultivated and isolated 355 strains and 784 strains of bacterium. In neutropenic patients, gram positive bacteria and gram negative bacterium accounted for 29.6% and 70.4%, respectively; in non-neutropenic patients, gram positive bacteria and gram-negative bacterium account for 45.0 % and 55.0 %, respectively. Pseud- omonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumanii,Escherichia coli and Stenotrophomonas malto- philia respectively was ranked TOP5 out of all pathogenic bacterium in neutropenic patients, and in non-neutro- penic patients, the Top 5 were Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella pneumo- nia and Staphylococcus haemolyticus. In the gram negative bacteria isolated from respiratory secretions samples of neutropenic patients, non-fermentative bacteria accounted for 52.9%, and in non-neutropenic patients, non-fer- mentative bacteria accounted for 30.5 % （P〈0.01）. In the blood samples of neutropenic patients, Escherichia coli accounted for 17.6% ,which was significantly higher than that of non-neutropenic patients. The relevance ratio of MRSA and MRCNS in neutropenic patients were both up to 100%. The relevance ratio of ESBLs strains produced by Escherichia coli and Klebsiella pneumonia in neutropenic patients were 57.6% and 31.9%, which were signifi- cantly higher than those of non-neutropenic patients. All the Enterococcus and Staphylococcus isolates from both neutropenic and non-neutropenic patients were susceptible to linezolid, vancomycin and teieoplanin. The Enter- obacteriaceae isolated from neutropenic patients kept highly sensitive to imipenem and meropenem. The non-fer- mentative bacteria isolated from neutropenie patients showed high resistance to carhapenemes, the resistance to imipenem and meropenem was up to 42.1 % and 31.6% respectively, which were significantly higher than those of non-neutropenic patients. Conclusions：Our data suggest that gram-negative bacteria, especially Enterobacteriaceae and non-fermentative bacteria, might be still the primary pathogens in neutropenic patients and antimicrobial re- sistant strains might be prevalent. Such data may have great significance for the empirical use of antimicrobial agents in the infection treatment in neutropenic patients.
出处
《临床血液学杂志（输血与检验）》
CAS
2017年第2期249-254,共6页
Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)
