摘要
目的 分析山西省肿瘤医院恶性肿瘤患者血流感染病原菌的分布及其耐药特点.方法 回顾性病例系列研究.选取2019年1月至2021年12月山西省肿瘤医院送检血培养的恶性肿瘤患者8 654例,抽取静脉血进行血液培养,采用WHONET5.6软件和SPSS 23.0软件对其血流感染病原菌分布及耐药情况进行分析.结果 共分离病原菌600株(6.9％),其中革兰阴性菌413株(68.8％),革兰阳性菌168株(28.0％);真菌19株(3.2％).革兰阴性菌前5位分别为大肠埃希菌(37.7％)、肺炎克雷伯菌(14.2％)、阴沟肠杆菌(4.5％)、铜绿假单胞菌(3.0％)、鲍曼不动杆菌(2.5％),革兰阳性菌前5位分别为金黄色葡萄球菌(4.2％)、屎肠球菌(4.0％)、人葡萄球菌(3.8％)、表皮葡萄球菌(3.5％)、链球菌属(3.0％);2019年至2021年除肺炎克雷伯菌外,其他主要病原菌构成比差异均无统计学意义(均P＞0.05).大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对氨苄西林的耐药率分别为94.7％(214/226)、100.0％(85/85)、96.3％(26/27),对环丙沙星的耐药率分别是61.9％(140/226)、17.6％(15/85)、7.4％(2/27),对头孢哌酮的耐药率分别为62.4％(141/226)、30.6％(26/85)、25.9％(7/27).铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类抗生素耐药率分别为5.5％(1/18)、93.3％(14/15).葡萄球菌属细菌以金黄色葡萄球菌、人葡萄球菌、表皮葡萄球菌为主,肠球菌属细菌以屎肠球菌与粪肠球菌为主.血培养阳性标本主要分布于血液科与重症监护病房(ICU),非霍奇金淋巴瘤(39株)与急性髓系白血病(12株)为主要病种.结论 该地区恶性肿瘤患者血流感染病原菌以革兰阴性菌为主,耐药状况普遍,医院应结合药敏试验合理使用抗菌药物.
Abstract
Objective To analyze the distribution and drug resistance of the pathogen of bloodstream infections in patients with malignancies in Shanxi Province Cancer Hospital.Methods A retrospective case series study was conducted.A total of 8 654 patients with malignancies whose blood culture was detected in Shanxi Province Cancer Hospital between January 2019 and December 2021 were collected,and venous blood was drawn for blood culture.WHONET 5.6 software and SPSS 23.0 software were used to analyze the distribution and drug resistance of the pathogen of bloodstream infections.Results A total of 600(6.9％)pathogens were isolated,including 413(68.8％)strains of Gram-negative bacteria,168(28.0％)strains of Gram-positive bacteria,19(3.2％)strains of fungi.The top 5 gram-negative bacteria were Escherichia coli(37.7％),Klebsiella pneumoniae(14.2％),Enterobacter cloacae(4.5％),Pseudomonas aeruginosa(3.0％),and Acinetobacter baumannii(2.5％).The top 5 gram-positive bacteria were Staphylococcus aureus(4.2％),Enterococcus faecium(4.0％),Staphylococcus hominis(3.8％),Staphylococcus epidermidis(3.5％)and Streptococcus(3.0％);except Klebsiella pneumoniae,there were no statistically significant differences in the composition ratio of other major pathogens from 2019 to 2021(all P＞0.05).The resistance rates of Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae to ampicillin were 94.7％(214/226),100.0％(85/85)and 96.3％(26/27);the resistance rates of those to ciprofloxacin were 61.9％(140/226),17.6％(15/85)and 7.4％(2/27);and the resistance rates of those to cefoperazone were 62.4％(141/226),30.6％(26/85)and 25.9％(7/27),respectively.The resistance rates of P.aeruginosa and Acinetobacter baumannii to carbapenems were 5.5％(1/18)and 93.3％(14/15).Staphylococcus aureus,Staphylococcus hominis,Staphylococcus epidermidis were predominantly Staphylococcus.Enterococcus faecium and Enterococcus faecalis were the main types of enterococcus.Positive blood culture samples were mainly distributed in hematology department and intensive care unit.Non-Hodgkin lymphoma(39 strains)and acute myeloid leukemia(12 strains)were the main diseases.Conclusions The main pathogen of bloodstream infection in patients with malignancies in this area is Gram-negative bacteria,and drug resistance is common.Hospitals should rationally use antibiotics by combining with drug sensitivity test.
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