2006-2007年中山大学附属肿瘤医院患者医院感染病原菌分布特点及耐药性分析

背景与目的：肿瘤患者免疫力低下，容易发生感染，不仅给肿瘤的治疗带来困难，也是肿瘤患者死亡的重要原因。本研究主要对发生医院感染的肿瘤住院患者的易感因素、病原菌分布及耐药情况进行分析。方法：回顾性调查中山大学附属肿瘤医院2006—2007年发生医院感染的952例住院患者的临床资料，采用EXCEL8．0和SPSS10．0对医院感染一般情况、病原菌分布及耐药情况进行统计和分析。结果：952例发生医院感染的患者中，分离出了病原菌794例，检出率为83．4％。其中检出革兰阴性杆菌321例，占所有病原菌的40．4％，主要是大肠埃希菌感染；真菌265例，占33．4％，以白色假丝酵母菌感染为主；革兰阳性球菌208例，占26．2％，主要是葡萄球菌属和链球菌属感染。药敏结果提示革兰阴性杆菌主要对亚胺培南、丁胺卡那敏感，而对氨苄西林的耐药率则在90％以上：革兰阳性球菌对万古霉素高度敏感。此次调查中没有发现对万古霉素耐药细菌，而对氨苄西林耐药严重：真菌对两性霉素B、伏立康唑及氟胞嘧啶敏感，而对氟康唑的敏感性稍差。结论：中山大学附属肿瘤医院2006—2007年住院患者医院感染病原菌主要为革兰阴性杆菌，临床用药应根据药敏结果合理使用抗生素，减少真菌感染和细菌耐药，从而有效预防和控制感染。

Distribution and drug resistance of pathogenic bacteria strains in nosocomial infection in Sun Yat-sen University Cancer Center from 2006 to 2007

Background and Objective： Tumor patients have an increased risk of nosocomial infection due to hypoimmunity. Infection may affect antitumor therapies and even lead to death. This study aimed to investigate the susceptible factors, the distribution and drug resistance of the pathogens from tumor patients who suffered from nosocomial infection. Methods： Clinical records of 952 infected patients in Cancer Center of Sun Yat-sen University during 2006-2007 were reviewed. The infection rate, pathogen spectum and drug resistance of nosocomial infection were analyzed with EXCEL8.0 and SPSS10.0 software. Results： Among the 952 patients, pathogens were detected in 794 patients, with a rate of 83.4%. Of the 794 patients, 321 （40.4%） had gram-negative bacilli （GNB） infection （mainly caused by Escherichia coli）, 265 （33.4%） had fungi infection （mainly caused by Candida albicans）, and 208 （26.2%） had gram-positive cocci （GPC） infection （mainly caused by staphylococcus and streptococcus species）. According to drug sensitivity and resistance test, GNB were sensitive to imipenem and amikacin, but strongly resistant to ampicillin with a rate of 〉90%; GPC were sensitive to vancomycin, but highly resistant against ampicillin; the fungi were sensitive to amphotericin B, voriconazole and flucytosine, but less sensitive to fluconazol. Conclusions= GNB comprises the majority of pathogens separated from the hospitalized tumor patients in Cancer Center of Sun Yat-sen University from 2006 to 2007. Rational use of antibiotics based on drug sensitivity test could reduce fungi infection and drug resistance, therefore, help to prevent and control nosocomial infection effectively.