某院肿瘤患者多重耐药菌感染的临床调查及耐药性分析

目的: 调查某院肿瘤患者多重耐药菌感染特点、病原菌分布及耐药性, 为临床合理应用抗菌药物, 预防和控制多重耐药菌感染提供参考依据。方法: 对某院2014年收治肿瘤患者的多重耐药菌感染情况进行回顾性调查分析。结果: 调查期间发生肿瘤患者多重耐药菌感染492例, 占医院感染的10.87%, 男女比例为1.83:1, 原发肿瘤肺癌居首。其中, 62.81%的患者接受过手术, 45.04%的患者接受过化疗, 感染部位以呼吸道、手术切口和泌尿道为主。分离出革兰阴性菌426株, 革兰阳性菌66株, 超广谱β-内酰胺酶(ESBLs)菌株分离率为86.62%, 耐甲氧西林葡萄球菌(MRS)检出率为91.38%。提示产ESBLs肠杆菌耐药严重, 仅对阿米卡星及碳青霉烯类药物显示出较好的敏感性;鲍曼不动杆菌对头孢哌酮舒巴坦敏感率最高, 为29.41%。未发现耐万古霉素葡萄球菌, 但检出1例耐万古霉素屎肠球菌。结论: 肿瘤患者是多重耐药菌感染的高发群体, 且细菌耐药性较高, 临床应予以重视, 加强抗菌药物合理使用, 积极控制病原菌的耐药性。

Clinical survey and drug resistance analysis of multidrug resistant bacteria causing infections in tumor patients

OBJECTIVE To investigate infectious status and drug resistance of multi-drug resistant bacteria among tumor patients to control resistant infections.METHODS Infectious data of tumor patients were reviewed from January to December 2014 in Tumor Hospital of Harbin Medical University.RESULTS Multi-drug resistant bacterial infection was identified in 492 tumor patients, and infection rate was 10.87%. Among them, male/female ratio was 1.83:1, and most infections were pneumonia. A total of 426 strains of gram-negative bacillus and 66 strains of gram-positive coccus were isolated, the detection rate of extended-spectrum β-lactamases (ESBLs) from gram-negative bacilli was 86.62% and rate of methicillin-resistant staphylococcus aureus (MRS) from gram-positive cocci was 91.38%. ESBLs-producing Enterobacteriaceae strains were found more sensitive to amikacin and carbapenems compared with other antimicrobial agents, 29.41% of Acinetobacter baumannii strains were susceptible to cefoperazone-sulbactam. Resistance analysis showed no Staphylococcal strains but only 1 strain of Enterococcus Faecium resistant to vancomycin.CONCLUSION Multi-drug resistant bacterial infection is common in tumor patients, which should be paid more attentions to strengthen rational antibiotic use as far as possible.