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

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.