肿瘤患者医院感染病原菌对抗菌药物的耐药性分析

目的 了解肿瘤住院患者医院获得病原菌的分布和体外药物敏感试验.方法 采用纸片扩散法(K-B法)和CLSI 2008年的判断标准,对238株肿瘤患者医院感染病原菌做药敏试验.结果 238株病原菌中革兰阳性球菌占26.9％,革兰阴性杆菌占63.9％,真菌占9.2％；检出前5位的病原菌依次为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌;大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别为74.3％和50.0％,亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢替坦等对大肠埃希菌和肺炎克雷伯菌敏感率较高；铜绿假单胞菌对哌拉西林/他唑巴坦、头孢吡肟、环丙沙星等敏感率高；耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球(MRSCN)检出率分别为55.0％和82.4％,葡萄球菌属对喹奴普汀/达福普汀、利奈唑胺、万古霉素和替加环素敏感.结论 肿瘤住院患者医院感染以革兰阴性杆菌为主,产ESBLs细菌阳性率高,应引起临床高度重视,加强肿瘤住院患者细菌耐药性监测,对于正确合理选用抗菌药物和控制细菌耐药性产生十分重要.

Antimicrobial resistance of pathogens causing nosocomial infections in tumor patients

OBJECTIVE To investigate distribution of the pathogens obtained from the hospitalized tumor patients and the in vitro drug susceptibility testing.METHODS Disc diffusion test(K-B method) and the determination criteria by CLSI of 2008 were employed to study the antimicrobial susceptibility testing for 238 strains of pathogens.RESULTS Of 238 clinical isolates,gram-negative bacilli accounted for 63.9%,gram-positive cocci accounted for 26.9%,respectively,and fungi accounted for 9.2%;the top five pathogens isolated were Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus,Klebsiella pneumoniae,and coagulase-negative Staphylococci;The positive rates of extended-spectrum-β-lactamases(ESBLs)-producing E.coli and K.pneumoniae were 74.3% and 50.0%,respectively;E.coli and K.pneumoniae were susceptible to imipenem,meropenem,piperacillin/tazobactam,and cefotetan etc;P.aeruginosa was susceptible to piperacillin/tazobactam,cefepime,and ciprofloxacin etc;the detection rates of MRSA and MRSCN were 55.0% and 82.4%,respectively;all Staphylococcus species were susceptible to couinaudputin/dalfopristin,linezolid,vancomycin,and tigecycline.CONCLUSION Gram-negative bacilli are dominant in the pathogens causing nosocomial infections in hospitalized tumor patients,the positive rate of ESBLs-producing strains is high,for which we should arouse great attention;it is very important for the reasonable use of antimicrobial drugs and the control of antimicrobial resistance to strengthen the monitoring of the bacterial resistance for the hospitalized tumor patients.