摘要
目的 了解肿瘤患者血流感染病原菌及其对抗菌药物的耐药性和敏感性。方法 收集2017年1月-2020年12月复旦大学附属肿瘤医院血流感染肿瘤患者的临床分离菌株,体外药敏试验采用VITEK2 Compact全自动微生物分析系统和K-B纸片扩散法,依据2020年美国临床实验室标准化协会文件进行结果判断。结果2017-2019年共收集血培养阳性菌株638株,革兰阴性菌和革兰阳性菌分别为447株(70.06%)和191株(29.94%),大肠埃希菌最常见,分离出248株(38.87%),其次为金黄色葡萄球菌83株(13.01%)和肺炎克雷伯菌71株(11.13%)。甲氧西林耐药的金黄色葡萄球菌、表皮葡萄球菌和其他葡萄球菌检出率分别为14.46%、84.61%和76.47%。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类耐药率<5.00%,第三代头孢菌素耐药的肠杆菌目细菌呈现上升趋势,该类耐药的大肠埃希菌和肺炎克雷伯菌检出率分别为69.76%和33.80%。铜绿假单胞菌对亚胺培南耐药率12.50%,鲍氏不动杆菌对亚胺培南和美罗培南耐药率均为35.71%。结论 血流感染患者临床分离菌中多药耐药菌占比较高,尤其第三代头孢菌素耐药肠杆菌目细菌。应加强耐药菌株医院感染预防和控制措施及抗菌药物临床合理应用,定期对血流感染病原菌的耐药性进行分析,为临床医生经验性治疗提供参考。
OBJECTIVE To understand the distribution and drug resistance of pathogens isolated from cancer patients with bloodstream infection. METHODS The clinical isolates were collected from the cancer patients with bloodstream infection who were treated in the Affiliated Hospital of Fudan University from Jan 2017 to Dec 2020. The in vitro drug susceptibility testing was performed by using VITEK2 Compact automatic microorganism analysis system and K-B disc diffusion method, and the result was judged based on the 2020 Clinical and Laboratory Standards Institute. RESULTS A total of 638 strains were cultured positive from blood specimens between 2017 and 2019, there were 447(70.06%) strains of gram-negative bacteria and 191(29.94%) strains of gram-positive bacteria. Escherichia coli(248 strains, 38.87%) was the most common, followed by Staphylococcus aureus(83 strains, 13.01%) and Klebsiella pneumoniae(71 strains, 11.13%). The isolation rates of methicillin-resistant S.aureus, Staphylococcus epidermidis and other species of Staphylococcus were 14.46%, 84.61% and 76.47%, respectively. The drug resistance rates of E.coli and K.pneumoniae to carbapenems were less than 5.00%. The Enterobacteriaceae strains that were resistant to the third generation cephalosporins showed an upward trend, and the isolation rates of E.coli and K.pneumoniae strains that were resistant to these drugs were 69.76% and 33.80%, respectively. The drug resistance rate of Pseudomonas aeruginosa strains to imipenem was 12.50%, and the drug resistance rates of Acinetobacter baumannii strains to imipenem and meropenem were 35.71%. CONCLUSION Multidrug-resistant organisms are dominant among the clinical isolated from the patients with bloodstream infection, especially the Enterobacteriaceae strains that are resistant to the third generation cephalosporins. It is necessary to take effective prevention measures, reasonably use antibiotics and regularly carry out the drug susceptibility testing for the pathogens causing bloodstreams infection so as to provide guidance for clinical experimental treatment.
作者
张树敬
陈祝俊
张菁
喻靓
张燕
卢仁泉
郭林
庄亦晖
ZHANG Shu-jing;CHEN Zhu-jun;ZHANG Jing;YU Liang;ZHANG Yan;LU Ren-quan;GUO Lin;ZHUANG Yi-hui(Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第6期846-851,共6页
Chinese Journal of Nosocomiology
关键词
血培养
药物敏感性试验
病原菌
第三代头孢菌素耐药大肠埃希菌
第三代头孢菌素耐药肺炎克雷伯菌
肿瘤患者
Blood culture
Drug susceptibility testing
Pathogen
Third generation cephalosporins-resistant Escherichia coli
Third generation cephalosporins-resistant Klebsiella pneumoniae
Tumor patient
