2019年至2021年血液病住院患者血流感染病原菌分布及耐药性分析

Distribution and drug resistance analysis of pathogenic bacteria of bloodstream infection in hospitalized patients with hematological diseases from 2019 to 2021

摘要:

目的 分析解放军总医院血液病住院患者血流感染病原菌的分布特点和耐药性，为临床合理选用抗菌药物提供参考依据。方法 对2019年至2021年血液病和非血液病住院患者送检的血培养及药敏结果进行回顾性分析，用VITEK-2微生物分析仪进行微生物鉴定和药敏试验。结果 血液病患者血培养阳性标本病原菌以革兰阴性杆菌为主（71.2%），其次是革兰阳性菌（26.8%）、真菌（2.0%）；主要病原菌有大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、铜绿假单胞菌等；主要革兰阴性菌对阿米卡星、亚胺培南、美罗培南敏感率较高；主要革兰阳性菌对万古霉素、利奈唑胺敏感率较高；葡萄球菌属未发现万古霉素、替加环素和利奈唑胺耐药株；分离的真菌对二性霉素B和伏立康唑的敏感率高。对血液病和非血液病患者血流感染的病原菌进行比较，发现血液病患者铜绿假单胞菌和嗜麦芽窄食单胞菌构成比高于非血液病患者，凝固酶阴性葡萄球菌和白色假丝酵母菌明显低于非血液病患者（P<0.05）。血液病患者大肠埃希菌对碳青霉烯类药物、喹诺酮类药物等的耐药率高于非血液病患者，差异有统计学意义（P<0.05）；肺炎克雷伯菌和铜绿假单胞菌对碳青霉烯类、喹诺酮类等抗菌药物的耐药率均低于非血液病患者，差异有统计学意义（P<0.05）。结论 革兰阴性菌是引起本院血液病住院患者血流感染最主要的病原菌，以大肠埃希菌最为常见，与本院非血液病患者病原菌分布结果大致相同。革兰阴性菌对阿米卡星、亚胺培南、美罗培南、哌拉西林/他唑巴坦敏感率高，革兰阳性菌对万古霉素、利奈唑胺敏感率高。本研究发现血液病患者大肠埃希菌对碳青霉烯类药物、喹诺酮类药物等的耐药率高于非血液病患者，在临床诊治中应加强对碳青霉烯类药物和喹诺酮类药物的关注和监控，及时进行病原菌和耐药性监测、正确选用抗菌药物、及早控制血流感染，对预后非常重要。

Abstract:

Objective To analyze the distribution characteristics and drug resistance of pathogenic bacteria of bloodstream infection in hospitalized patients with hematological diseases in Chinese PLA General Hospital，and to provide reference for the rational selection of antibiotics during clinical treatment.Methods A retrospective study was performed by reviewing the results of blood culture and drug susceptibility of hospitalized patients with hematological and non-hematological diseases from 2019 to 2021. VITEK-2 system was used for identification and antimicrobial susceptibility test.Results Gram-negative bacilli（71.2%） were the main pathogenic bacteria in patients with hematological diseases suffered from bloodstream infection，followed by gram-positive bacteria（26.8%） and fungi（2.0%）. The main pathogens were Escherichia coli，Klebsiella pneumoniae，coagulase-negative staphylococcus， Pseudomonas aeruginosa，etc. The main gram-negative isolates were more sensitive to amikacin，imipenem and meropenem， those main gram-positive ones to vancomycin and linezolid，and fungal isolates to amphotericin B and voriconazole. Staphylococcus were not resistant to vancomycin，tigecycline or linezolid. Comparison was made between the pathogens of bloodstream infection in patients with hematological diseases and those with non-hematological diseases，which found that the proportion of Pseudomonas aeruginosa and Stenotrophomonas maltophilia was significantly higher in the former，while that of coagulase-negative Staphylococci and Candida albicans was significantly lower（P<0.05）. The resistance rate of Escherichia coli to carbapenems and quinolones in patients with hematological diseases was higher than that of patients with non-hematological diseases，and the difference was statistically significant（P<0.05）；the resistance rate of Klebsiella pneumoniae and Pseudomonas aeruginosa to antibacterial drugs such as carbapenems and quinolones was lower than that of patients with non-hematological diseases， and the difference was statistically significant（P<0.05）.Conclusion Gram-negative bacteria are the most common pathogens causing bloodstream infection in patients with hematological diseases，especially Escherichia coli， which is nearly the same to that in patients with non-hematological diseases in our hospital. Gram-negative bacteria have high sensitivity to amikacin，imipenem，meropenem，piperacillin/tazobactam，and gram-positive bacteria have high sensitivity to vancomycin and linezolid. This study finds that the drug resistance rate of Escherichia coli to carbapenems and quinolones in patients with hematological diseases was higher than that of patients with non-hematological diseases，and the attention and monitoring of carbapenems and quinolones should be strengthened in clinical diagnosis and treatment. Timely monitoring of pathogens and drug resistance，reasonable selection of antibiotics， and early control of bloodstream infections are very important for prognosis.