| 摘要: |
| ［摘要］ 目的 分析2010年1月至2019年12月我院血液科细菌感染患者的病原菌类型、分布特征及耐药性，为临床抗感染治疗提供参考。方法 收集2010年1月至2019年12月广州市第一人民医院血液科发生细菌感染的1 221例患者的病历资料。患者疾病类型包括血液系统疾病以及非血液系统疾病。统计分析病原菌的类型、分布特征及耐药性，并比较重型再生障碍性贫血患者与恶性血液病患者感染病原菌的情况差异。结果 1 221株病原菌中革兰阴性菌803株（65.77%），革兰阳性菌418株（34.23%）。革兰阴性菌中占比前三位的分别是大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌。革兰阳性菌中占比前三位的分别是屎肠球菌、溶血葡萄球菌和金黄色葡萄球菌。大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(ESBLs)的检出率分别为60.87%和58.03%，其对亚胺培南的耐药率分别为3.38%和4.66%。2010—2019年耐碳青霉烯肠杆菌(CRE)的检出率总体呈上升趋势。铜绿假单胞菌耐药性较低的抗生素有亚胺培南、美罗培南、头孢他啶、头孢吡肟、哌拉西林-他唑巴坦、氨基糖苷类和喹诺酮类。耐亚胺培南的铜绿假单胞菌株（IRPA）和耐亚胺培南的鲍曼不动杆菌株（IRAB）的检出率分别为17.74%（22/124）和13.64%（6/44）。嗜麦芽窄食单胞菌耐药性较低的抗生素有头孢他啶、左氧氟沙星和复方新诺明。本研究耐甲氧西林金黄色葡萄球菌（MRSA）检出率为20.59%（14/68），未检出万古霉素和利奈唑胺耐药金黄色葡萄球菌株。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为90.28%（130/144）。粪肠球菌和屎肠球菌对万古霉素和利奈唑胺的耐药率均较低。相对于重型再生障碍性贫血（SAA）患者，屎肠球菌和金黄色葡萄球菌感染在恶性血液病组中发生率更高（P<0.05）。结论 血液科住院患者感染高发，尤其以SAA和血液系统恶性肿瘤患者常见。革兰阴性菌是血液病患者感染的主要病原菌。对于合并感染的血液病患者应及时进行病因检查，临床医师可根据医院细菌病原体类型特点和耐药情况进行经验性抗感染治疗。 |
| 关键词: 血液科 感染 病原菌 耐药性 |
| DOI：10.3969/j.issn.1674-3806.2021.11.10 |
| 分类号:R 515 |
| 基金项目:广州市第一人民医院红棉计划项目（编号：M2019008） |
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| A single-center study on the distribution and drug resistance of bacteria-infected pathogens in bacterial infection patients in hematology department of our hospital from 2010 to 2019 |
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ZHOU Wei, XU Shi-lin, DONG Mei-hua, et al.
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Department of Hematology, Guangzhou First People′s Hospital, Guangdong 510180, China
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| Abstract: |
| ［Abstract］ Objective To analyze the types, distribution characteristics and drug resistance of pathogens in patients with bacterial infections in the Department of Hematology of Guangzhou First People′s Hospital during January 2010 and December 2019 to provide reference for clinical anti-infection treatment. Methods The medical records of 1 221 patients who had bacterial infections in the Department of Hematology, Guangzhou First People′s Hospital from January 2010 to December 2019 were collected. The patients′ disease types included the hematology systemic and non-hematology systemic diseases. The types, distribution characteristics and drug resistance of the pathogens were statistically analyzed, and the differences in infections of the pathogens between patients with severe aplastic anemia(SAA) and those with hematological malignancies were compared. Results Among the 1 221 strains of pathogens, 803 strains(65.77%) were gram-negative bacteria and 418 strains(34.23%) were gram-positive bacteria. The top three gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. The top three gram-positive bacteria were Enterococcus faecium, Staphylococcus haemolyticus and Staphylococcus aureus. The detection rates of extended-spectrum β-lactamases(ESBLs) in Escherichia coli and Klebsiella pneumoniae were 60.87% and 58.03%, respectively, and their resistance rates to imipenem were 3.38% and 4.66%, respectively. From 2010 to 2019, the detection rate of carbapenem-resistant Enterobacteriaceae(CRE) showed an overall upward trend. Antibiotics with lower resistance to Pseudomonas aeruginosa included imipenem, meropenem, ceftazidime, cefepime, piperacillin-tazobactam, aminoglycosides and quinolones. The detection rates of imipenem-resistant Pseudomonas aeruginosa(IRPA) and imipenem-resistant Acinetobacter baumannii(IRAB) were 17.74%(22/124) and 13.64%(6/44), respectively. Antibiotics with lower resistance to Stenotrophomonas maltophilia included ceftazidime, levofloxacin and compound sulfamethoxazole. In this study, the detection rate of methicillin-resistant Staphylococcus aureus(MRSA) was 20.59%(14/68), and vancomycin and linezolid-resistant Staphylococcus aureus strains were not detected. The detection rate of methicillin-resistant coagulase negative Staphylococcus(MRCNS) was 90.28%(130/144). Both Enterococcus faecalis and Enterococcus faecium had lower resistance rates to vancomycin and linezolid. Compared with those in the SAA patients, the incidence rates of Enterococcus faecium and Staphylococcus aureus infections were higher in the hematological malignancies group(P<0.05). Conclusion Inpatients in hematology department have a high incidence of infections, among whom the patients with SAA and hematological malignancies are particularly common. Gram-negative bacteria are the main pathogens of the infections in patients with blood diseases. For patients suffering from hematological diseases complicated with infections, etiological examination should be carried out in time. Clinicians can conduct empirical anti-infection treatments according to the characteristics of the bacterial pathogen types and drug resistances in the hospital. |
| Key words: Department of Hematology Infection Pathogens Drug resistance |
