单中心血液肿瘤患儿合并感染病原菌分布及耐药性病例系列报告
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摘要
目的回顾性分析血液肿瘤患儿感染病原菌的分布情况及药敏结果,为合理抗感染治疗提供依据。方法菌株来源为2016年1月1日至2017年6月30日首都医科大学附属北京儿童医院(我院)血液肿瘤中心因怀疑感染而送检、病原培养阳性且排除污染和定植的标本,分析病原菌的构成和耐药情况。药敏试验采用纸片扩散法或自动化仪器法,按照2014年美国临床实验室标准化委员会标准进行结果判定。结果 2 095例次病原学培养阳性标本中共分离到病原菌2 188株,革兰阴性菌1 053株(48.1%)、革兰阳性菌837株(38.3%)、真菌298株(13.6%)。革兰阴性菌中以肺炎克雷伯杆菌、铜绿假单胞菌、阴沟肠杆菌和大肠埃希菌为主要致病菌。革兰阳性菌以凝固酶阳性表皮葡萄球菌、人葡萄球菌和凝固酶阴性葡萄球菌多见。药敏情况:①耐甲氧西林葡萄球菌占革兰阳性菌的41.6%(348/837),以表皮葡萄球菌(84.9%,169/199)和人葡萄球菌(90.8%,129/142)为主,未检测到万古霉素、利奈唑胺和替加环素耐药菌株。②超广谱β内酰胺酶(ESBL)阳性菌占革兰阴性菌的31.9%(336/1 053),以肺炎克雷伯杆菌(63.8%,134/210)和大肠埃希菌(92.8%,90/97)为主;碳青霉烯类耐药肠杆菌科细菌占革兰阴性菌的23.6%(248/1 053),以肺炎克雷伯杆菌(63.8%,134/210)、大肠埃希杆菌(51.5%,50/97)和阴沟肠杆菌(34.5%,38/110)为主;肠杆菌科细菌对亚胺培南和美罗培南的耐药率均接近或超过50%,但对替加环素的耐药率为0.9%～13.4%,对阿米卡星的耐药率为10.0%～26.8%。③多重耐药、广泛耐药和全耐药鲍曼不动杆菌占全部鲍曼不动杆菌的32.6%(28/86)。鲍曼不动杆菌对碳青霉烯类的耐药率为52.3%～58.1%,对多黏菌素的耐药率为1.2%。结论血液肿瘤患儿合并感染以革兰阴性菌为主,耐药菌及条件致病菌检出率有增长趋势。
Objective This study aimed to explore the pathogens and the antibiotic resistance in consecutive cases,and to provide a basis for the rational regarding antibiotic use. Methods We performed a retrospective chart review of all patients with pediatric hematology and oncology desease in Beijing Children's Hospital from January 2016 to June 2017. All patients were selected based on clinical presentation. Bacterial strains after removal of contaminated and colonized specimens were analyzed. The drug sensitivity test was determined by disk diffusion method or automatic instrument method according to the 2014(CLSI) standard of American Clinical Laboratory Standardization Committee. Results Of all 2,188 strains isolated from 2,095 samples, 48.1% were gram-negative bacteria; 38.3% were gram-positive bacteria,and 13.6% were a fungal infection. The primary pathogens were gram-negative bacteria including Klebsiella pneumoniae,Pseudomonas aeruginosa, Enterobactercloacae, and Escherichia coli. Gram-positive bacteria were mainly coagulase-positive Staphylococcus epidermidis and human Staphylococcus. A total of methicillin-resistant Staphylococcus(MRS) gram-positive bacterial strains(41.6%,348/837) were identified, and Staphylococcus epidermidis(84.9%, 169/199) and human staphylococci(90.8%, 129/142) were the main types, but vancomycin-and linazolamide-resistant strains were not detected.Extended-spectrum β-lactamase-positive bacteria accounted for 31.9%(336/1 053)gram-negative bacteria, mainly K. pneumoniae(63.8%,134/210) and E. coli(92.8%, 90/97). As for gram-negative bacteria, there were 23.6%(248/1 053)carbapenem-resistant Enterobacteriaceae-positive bacteria, mainly K. pneumoniae(63.8%, 134/210),E. coli(51.5%, 50/97), and Enterobactercloacae(34.5%,38/110).The drug resistance rate for imipenem and meropenem was about or over 50%, but the resistance rate for tigecycline and amikacin was 0.9%-13.4% and 10%-26.8%, respectively. There were 86 Acinetobacter baumaniistrains, in which there were 32.6%(28/86) isolates drug-resistant A.baumanniistrains.The drug resistance rates of A. baumanii to carbapenem and polymyxin were 52.3%-58.1% and 1.2%. Conclusion Our report revealed a prevalence of pathogens of pediatric patients with hemato-oncological malignancies. The Gram-negative bacteria was the main pathogen. An increasing incidence of drug-resistant bacteria and opportunistic pathogens was demonstrated.
Objective This study aimed to explore the pathogens and the antibiotic resistance in consecutive cases,and to provide a basis for the rational regarding antibiotic use. Methods We performed a retrospective chart review of all patients with pediatric hematology and oncology desease in Beijing Children's Hospital from January 2016 to June 2017. All patients were selected based on clinical presentation. Bacterial strains after removal of contaminated and colonized specimens were analyzed. The drug sensitivity test was determined by disk diffusion method or automatic instrument method according to the 2014(CLSI) standard of American Clinical Laboratory Standardization Committee. Results Of all 2,188 strains isolated from 2,095 samples, 48.1% were gram-negative bacteria; 38.3% were gram-positive bacteria,and 13.6% were a fungal infection. The primary pathogens were gram-negative bacteria including Klebsiella pneumoniae,Pseudomonas aeruginosa, Enterobactercloacae, and Escherichia coli. Gram-positive bacteria were mainly coagulase-positive Staphylococcus epidermidis and human Staphylococcus. A total of methicillin-resistant Staphylococcus(MRS) gram-positive bacterial strains(41.6%,348/837) were identified, and Staphylococcus epidermidis(84.9%, 169/199) and human staphylococci(90.8%, 129/142) were the main types, but vancomycin-and linazolamide-resistant strains were not detected.Extended-spectrum β-lactamase-positive bacteria accounted for 31.9%(336/1 053)gram-negative bacteria, mainly K. pneumoniae(63.8%,134/210) and E. coli(92.8%, 90/97). As for gram-negative bacteria, there were 23.6%(248/1 053)carbapenem-resistant Enterobacteriaceae-positive bacteria, mainly K. pneumoniae(63.8%, 134/210),E. coli(51.5%, 50/97), and Enterobactercloacae(34.5%,38/110).The drug resistance rate for imipenem and meropenem was about or over 50%, but the resistance rate for tigecycline and amikacin was 0.9%-13.4% and 10%-26.8%, respectively. There were 86 Acinetobacter baumaniistrains, in which there were 32.6%(28/86) isolates drug-resistant A.baumanniistrains.The drug resistance rates of A. baumanii to carbapenem and polymyxin were 52.3%-58.1% and 1.2%. Conclusion Our report revealed a prevalence of pathogens of pediatric patients with hemato-oncological malignancies. The Gram-negative bacteria was the main pathogen. An increasing incidence of drug-resistant bacteria and opportunistic pathogens was demonstrated.
引文
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[2]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测.中国感染与化疗杂志,2015,15(5):401-410
[3]Al-AnaziKA,AbdalhamidB,Alshibani Z.et al.Acinetobacter baumannii Septicemia in a Recipient of an Allogeneic Hematopoietic Stem Cell Transplantation.Case Rep Transplant,2012:646195
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[5]Gudiol C,Bodm M,Simonetti A,et al.Changing aetiology,clinical features,antimicrobial resistance,and outcomes of bloodstream infection in neutropenic cancer patients.Clin Mincrobiol Infect,2013,19(5):474-479
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[8]王启,王辉,俞云松,等.2014年中国15家教学医院革兰阴性杆菌耐药性监测分析.中华内科杂志,2015,54(10):837-845
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[11]Tascini C,Jagliaferri E,Giani T,et al.Synergistic activity of colistin plus rifampin against colistin-resistant KPC-producing Klebsiella pneumoniae.Antimicrob Agents Chemother,2013,57 (8 ):3990‐3993
[12]徐春晖,林青松,孙福军,等.儿童和成人血液病患者血培养病原菌分布及耐药性分析.国际检验医学杂志,2017,38(7):990-992
[13]董方,王艳,刘锡青,等.2009-2015年北京儿童医院临床分离细菌的分布及耐药性监测.中国感染与化疗杂志,2017,17(1):61-70
[14] Lai CH,Wong WW,Chin C,et al.Central venous catheter-related Stenotrophomonas maltophilia bacteraemia and associated relapsing bacteraemia in haematology and oncology patients.Clin Microbiol Infect,2006,12(10):986-991
[15]王璐,杨辰,张倩,等.2010至2012年北京协和医院单中心血液科非移植病房细菌感染病原菌分布及临床特点分析.中国医学科学院学报,2014,36(4):439-445
[16]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测.中国感染与化疗杂志,2016,16(6):685-694
[17] Aitken SL,Tarrand JJ,Deshpande LM,et al.High Rates of Nonsusceptibility to Ceftazidime-avibactam and Identification of New Delhi Metallo-β-lactamase Production in Enterobacteriaceae Bloodstream Infections at a Major Cancer Center.Clin Infect Dis,2016.63(7):954-958
[18]LeibmanV,MartinET,Tal-Jasper R,et al.Simple bedside score to optimize the time and the decision to initiate appropriate therapy for carbapenem-resistant Enterobacteriaceae.Ann ClinMicrobiol Antimicrob,2015,14:31
[2]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测.中国感染与化疗杂志,2015,15(5):401-410
[3]Al-AnaziKA,AbdalhamidB,Alshibani Z.et al.Acinetobacter baumannii Septicemia in a Recipient of an Allogeneic Hematopoietic Stem Cell Transplantation.Case Rep Transplant,2012:646195
[4]Shi Q,Pan J,Ma Y,et al.Knowledge and practice of Chinese physicians toward carbapenem-resistant enterobacteriaceae:a nationwide cross-sectional survey in top 100 hospitals.J Thorac Dis,2018,10(7):4396-4402
[5]Gudiol C,Bodm M,Simonetti A,et al.Changing aetiology,clinical features,antimicrobial resistance,and outcomes of bloodstream infection in neutropenic cancer patients.Clin Mincrobiol Infect,2013,19(5):474-479
[6] Centers for Disease Control and Prevention (CDC).Vital signs:carbapenem-resistant Enterobacteriaceae.MMWR Morb Mortal Wkly Rep,2013,62(9):165-170
[7]Al-Dhaheri AS,Al-Niyadi MS,Al-Dhaheri AD,et al.Resistancepatterns of bacterial isolates to antimicrobials from 3 hospitals in the United Arab Emirates.Saudi Med J,2009,30(5):618-623
[8]王启,王辉,俞云松,等.2014年中国15家教学医院革兰阴性杆菌耐药性监测分析.中华内科杂志,2015,54(10):837-845
[9]Van Duin D,Kaye KS,Neuner EA,et al.Carbapenem‐resistant Enterobacteriaceae:a review of treatment and outcomes.DiagnMicrobiol Infect Dis,2013,75(2):115-120
[10]Daikos GL,Tsaousi S,Tzouvelekis LS,et al.Carbapenemase-producing Klebsiella pneumoniae bloodstream infections:lowering mortality by antibiotic combination schemes and the role of carbapenems.Antimicrob Agents Chemother,2014,58(4):2322‐2328
[11]Tascini C,Jagliaferri E,Giani T,et al.Synergistic activity of colistin plus rifampin against colistin-resistant KPC-producing Klebsiella pneumoniae.Antimicrob Agents Chemother,2013,57 (8 ):3990‐3993
[12]徐春晖,林青松,孙福军,等.儿童和成人血液病患者血培养病原菌分布及耐药性分析.国际检验医学杂志,2017,38(7):990-992
[13]董方,王艳,刘锡青,等.2009-2015年北京儿童医院临床分离细菌的分布及耐药性监测.中国感染与化疗杂志,2017,17(1):61-70
[14] Lai CH,Wong WW,Chin C,et al.Central venous catheter-related Stenotrophomonas maltophilia bacteraemia and associated relapsing bacteraemia in haematology and oncology patients.Clin Microbiol Infect,2006,12(10):986-991
[15]王璐,杨辰,张倩,等.2010至2012年北京协和医院单中心血液科非移植病房细菌感染病原菌分布及临床特点分析.中国医学科学院学报,2014,36(4):439-445
[16]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测.中国感染与化疗杂志,2016,16(6):685-694
[17] Aitken SL,Tarrand JJ,Deshpande LM,et al.High Rates of Nonsusceptibility to Ceftazidime-avibactam and Identification of New Delhi Metallo-β-lactamase Production in Enterobacteriaceae Bloodstream Infections at a Major Cancer Center.Clin Infect Dis,2016.63(7):954-958
[18]LeibmanV,MartinET,Tal-Jasper R,et al.Simple bedside score to optimize the time and the decision to initiate appropriate therapy for carbapenem-resistant Enterobacteriaceae.Ann ClinMicrobiol Antimicrob,2015,14:31