9例中性粒细胞缺乏患者血流感染病原菌的分布及药敏分析
|
摘要
目的分析成人中性粒细胞缺乏(粒缺)患者血流感染(BSI)的临床特点及病原菌分布、耐药性特点,为临床抗感染治疗提供依据。方法回顾性分析北京大学第一医院2006-06-01—2016-05-31确诊为血流感染的中性粒细胞缺乏患者91例病例资料及病原菌药敏特点。结果本组患者平均年龄(45. 6±17. 9)岁;男性患者48例,占52. 7%;血液系统恶性疾病患者76例,占83. 5%;院内死亡率28. 6%。继发血流感染最常见的原发感染部位分别为肺部(28. 6%)、泌尿系统(11. 0%)和肛周部位(7. 7%),26. 4%患者未能明确感染部位。病原菌分布上,革兰氏阴性杆菌占73. 6%,革兰氏阳性球菌占15. 4%,真菌占11. 0%。最常见的病原菌依次为大肠埃希菌(25. 3%)、铜绿假单胞菌(18. 7%)和肺炎克雷伯菌(15. 4%)。大肠埃希菌及肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)率分别为65. 2%和50. 0%;未检测到万古霉素耐药葡萄球菌及肠球菌。结论本研究中,粒缺成人患者血流感染病原菌的构成以革兰氏阴性杆菌为主。定期开展医疗机构内特定人群的细菌耐药监测工作,对于指导抗菌药物合理应用及院感管理十分重要。
Objective To investigate the clinical features as well as the pathogenic organisms isolated from blood samples distribution and antimicrobial susceptibility profiles in adult neutropenic patients with bloodstream infection( BSI). Methods Electronic medical records of 91 adult neutropenic patients with BSI were reviewed from 1 June 2006 to 31 May2016 in Peking University First Hospital. Results The average age of these patients was( 45. 6 ± 17. 9) years. Forty eight patients( 52. 7%)were men. The patients with malignant hematologic diseases accounted for 83. 5%. The total mortality during the hospitalization period was28. 6%. The primary infective sites accounting for BSI were as follows:lungs( 28. 6%),urinary tract( 11. 0%) and perianal region( 7. 7%).Gram negative bacilli was the main pathogenic organism( 73. 6%). The isolate rates of gram positive cocci and fungi were 15. 4% and 11. 0%respectively. The most common organisms of BSI in these neutropenic patients were Escherichia coli( 25. 3%), Pseudomonas aeruginosa( 18. 7%),and Klebsiella pneumonia( 15. 4%). The rates of extended-spectrum-β-lactamases( ESBLs) producing strains of Escherichiacoli and Klebsiella pneumonia were 65. 2% and 50. 0%. No vancomycin resistant gram positive cocci were found.Conclusion In this study,gram-negative bacteria,especially Enterobacteriaceae and Pseudomonas aeruginosa were mainly isolated strains in febrile neutropenic patients. It is important to monitor BSI bacteriological prolife and drug resistance pattern in patients with certain kinds of diseases for rational use of antibiotics and hospital infection control.
Objective To investigate the clinical features as well as the pathogenic organisms isolated from blood samples distribution and antimicrobial susceptibility profiles in adult neutropenic patients with bloodstream infection( BSI). Methods Electronic medical records of 91 adult neutropenic patients with BSI were reviewed from 1 June 2006 to 31 May2016 in Peking University First Hospital. Results The average age of these patients was( 45. 6 ± 17. 9) years. Forty eight patients( 52. 7%)were men. The patients with malignant hematologic diseases accounted for 83. 5%. The total mortality during the hospitalization period was28. 6%. The primary infective sites accounting for BSI were as follows:lungs( 28. 6%),urinary tract( 11. 0%) and perianal region( 7. 7%).Gram negative bacilli was the main pathogenic organism( 73. 6%). The isolate rates of gram positive cocci and fungi were 15. 4% and 11. 0%respectively. The most common organisms of BSI in these neutropenic patients were Escherichia coli( 25. 3%), Pseudomonas aeruginosa( 18. 7%),and Klebsiella pneumonia( 15. 4%). The rates of extended-spectrum-β-lactamases( ESBLs) producing strains of Escherichiacoli and Klebsiella pneumonia were 65. 2% and 50. 0%. No vancomycin resistant gram positive cocci were found.Conclusion In this study,gram-negative bacteria,especially Enterobacteriaceae and Pseudomonas aeruginosa were mainly isolated strains in febrile neutropenic patients. It is important to monitor BSI bacteriological prolife and drug resistance pattern in patients with certain kinds of diseases for rational use of antibiotics and hospital infection control.
引文
[1]中华医学会血液学分会、中国医师协会血液科医师分会,中国中性粒细胞缺乏伴发热患者抗菌药物临床应用指南(2016年版)[J].中华血液学杂志,2016,37(5):353-359
[2]闫晨华,徐婷,郑晓云,等.中国血液病患者中性粒细胞缺乏伴发热的多中心、前瞻性流行病学研究[J].中华血液学杂志,2016,37(3):177-182.
[3]马序竹,郑波,李湘燕,等,成人血流感染的临床特点及病原学分析[J].中华医院感染学杂志,2017,27(17):3860-3863.
[4] GUSTINETTI G,MIKULSKA M. Bloodstream infections in neutropenic cancer patients:A practical update[J],Virulence,2016,7(3):280-297.
[5]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[2]闫晨华,徐婷,郑晓云,等.中国血液病患者中性粒细胞缺乏伴发热的多中心、前瞻性流行病学研究[J].中华血液学杂志,2016,37(3):177-182.
[3]马序竹,郑波,李湘燕,等,成人血流感染的临床特点及病原学分析[J].中华医院感染学杂志,2017,27(17):3860-3863.
[4] GUSTINETTI G,MIKULSKA M. Bloodstream infections in neutropenic cancer patients:A practical update[J],Virulence,2016,7(3):280-297.
[5]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.