摘要
目的分析血液病患者发生血流感染的病原菌分布情况及耐药性,为临床合理使用抗菌药物、有效控制感染提供可靠依据。方法回顾分析64例血流感染患者临床资料,了解其临床特点、血流感染病原菌种类及药敏情况。结果 64例血流感染患者送检的272份血液标本中共培养出77株(28.30%)病原菌,其中G-菌60株(占77.92%)、G+菌14株(占18.18%)、真菌3株(3.90%),1例患者发生混合细菌感染。分离的病原菌中,主要为大肠埃希菌(41.55%)、肺炎克雷伯菌(12.99%)、凝固酶阴性葡萄球菌(11.69%)、金黄色葡萄球菌属(3.90%)。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、肺炎克雷伯菌检出率分别为71.88%和50.00%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为33.33%和88.88%。G-菌对美罗培南、哌拉西林-他唑巴坦、阿米卡星耐药率低,葡萄球菌对万古霉素、利奈唑胺、利福平耐药率低。结论引起血液病患者出现血流感染的主要致病菌为G-菌,对G-菌及G+菌最敏感的药物分别为美罗培南及万古霉素、利奈唑胺,建议选用抗G-菌为主、兼顾G+菌的抗菌药物进行经验性治疗,必要时加用抗真菌药物。
Objective To study the distribution and drug resistance of blood stream infection(BSI)in hematologic patients,so as to guide the clinical use of antibiotics.Methods Sixty-four BSI patients hospitalized from Jan 2010 to Oct 2013 were enrolled to perform retro-spective analysis on clinic data in order to understand the clinical features,the bacterial identification and drug sensitivity.Results All pa-tients had fever,and 74.03%had infection lesions,mostly in lungs.A total of 77 strains(28.30%)of pathogenic bacteria were isolated,inclu-ding 60 gram-negative (77.92%),14 gram-positive (18.18%)and 3 fungi(3.90%).Mixed infection was found in 1 patient.The isolated pathogenic bacteria were mainly Escherichia coli (41.55%),klebsiella pneumonia (12.99%),coagulase-negative staphylococci (11.69%) and staphylococci aureus(3.90%).The detection rates of Escherichia coli and klebsiella pneumonia producing super spectrum βlactamases (ESBLs)were 71.88% and 50.00%,respectively;those of methicillin resistant S aureus (MRSA)and meticillin resistant coagulase-nega-tive staphylococcus(MRCNS)were 33.33% and 88.88%,respectively.Gram-negative bacilli were relatively susceptible to meropenem,pip-eracillin-tazobactam and amikacin.Staphylococcus isolates were susceptible to vancomycin,linezolid and rifampicin.Conclusion The patho-genic bacteria inducing BSI are mainly gram negative,especially the Escherichia coli,bacteria.For G+and G-bacteria,meropenem and van-comycin linezolid are the most sensitive drugs respectively.It is suggested that empirical treatment of antimicrobial agents like anti G-bacteria and G+bacteria should be used,and antifungal drugs should be added when necessary.
出处
《安徽医学》
2014年第5期568-571,共4页
Anhui Medical Journal
关键词
血液病患者
血流感染
致病菌
耐药性
Hematologic patients
Blood stream infection
Bacterium
Drug resistance
