Distribution and drug resistance of intestinal and oropharyngeal colonization of bacteria and pathogens causing bloodstream infection in hematopoietic stem cell transplantation patients
Distribution and drug resistance of intestinal and oropharyngeal colonization of bacteria and pathogens causing bloodstream infection in hematopoietic stem cell transplantation patients
OBJECTIVE To explore distribution and drug resistance of intestinal and oropharyngeal colonization of bacteria and pathogens causing bloodstream infection in hematopoietic stem cell transplantation patients so as to provide data for reasonable clinical use of antibiotics.METHODS The clinical data,active screening information and blood culture information were collected from the patients of blood purification wards from Jan 2018 to Dec 2023 and were retrospectively investigated.The distribution and drug resistance of the isolated pathogens were ob-served.RESULTS Among the 3 686 HSCT patients,256 case-times(6.95％)of patients had bloodstream infec-tion.Gram-negative bacteria(81.25％)were dominant among the pathogens causing the bloodstream infection;Klebsiella pneumoniae,Escherichia coli and Enterobacter cloacae were the predominant species of the gram-neg-ative bacteria,showing the same distribution with the active screening of colonized gram-negative bacteria.The drug resistance rates of K.pneumoniae and E.cloacae strains to carbapenems and tigecycline were higher in the bloodstream infection group than in the oropharyngeal swab group(P＜0.05);the drug resistance rate of the Pseudomonas aeruginosa strains to aztreonam was high,and the drug resistance rate of the Stenotrophomonas maltophilia strains to minocycline was high.Both the isolation rate and constituent ratio of the carbapenem-resist-ant K.pneumoniae(CRKP)strains were high in the bloodstream infection group and the rectal swab group,and there was no significant difference in the result of drug susceptibility testing.The isolation rate and constituent ra-tio of the CRKP strains were high in the oropharyngeal swab group,and the drug resistance rate to amikacin was higher in the oropharyngeal swab group than in the bloodstream infection group(P＜0.05).The incidence rate of secondary bloodstream infection caused by colonization of carbapenem-resistant Enterobacteriaceae(CRE)was 15.45％in the rectal swab group,18.52％in the oropharyngeal swab group;the incidence rate of secondary bloodstream infection caused by colonization of CRKP was 31.25％in the oropharyngeal swab group;the incidence rates of secondary blood-stream infections caused by colonization of CRKP,carbapenem-resistant E.coli(CREC)and carbapenem-resistant E.cloacae(CRECL)were respectively 18.03％,11.11％and 15.38％in the rectal swab group,and the drug resistance spectrum was highly consistent.The drug resistance rates of the CRKP strains to amikacin,fosfomycin and polymyxin B ranged between 0 and 33.33％,while the drug resistance rates to tigecycline varied from 40.98％to 56.25％.CONCLUSION It is necessary to focus on the active screening of intestinal colonization of CRE and oropharyngeal colonization of CRKP for the HSCT patients so as to take targeted prevention and control measures for suspected bloodstream infection based on the characteristics of drug resistance.
维普
万方数据