血液系统恶性肿瘤感染患儿的病原菌分布及耐药性分析

摘要]目的：了解血液系统恶性肿瘤感染患儿的病原菌特点及耐药情况，为临床抗生素的合理应用提供依据。方法：回顾性分析我院2012-2017年门诊及住院、确诊为血液系统恶性肿瘤且合并感染的患儿分离出的病原菌分布特点及其对抗生素的耐药情况。结果：322例血液系统恶性肿瘤合并感染的患儿共分离出致病菌709株，最常见的感染部位为血液（38.93%）和呼吸系统（33.85%）。以革兰阴性菌居多，共466株，主要包括肺炎克雷伯菌、嗜麦芽窄食单胞菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌及人苍白杆菌等，对左氧氟沙星、环丙沙星、阿米卡星、哌拉西林/他唑巴坦、亚胺培南（嗜麦芽窄食单胞菌除外）等耐药率较低；检出革兰阳性菌227株，主要包括表皮葡萄球菌、金黄色葡萄球菌、人葡萄球菌、肺炎链球菌、溶血葡萄球菌、粪肠球菌及屎肠球菌等，对环丙沙星、利奈唑胺、万古霉素耐药率较低；检出白色假丝酵母菌16株，对伊曲康唑、伏立康唑、氟康唑和两性霉素B均敏感。结论：血液系统恶性肿瘤患儿以呼吸系统和血流感染为主，碳青霉烯类或含酶抑制剂类抗生素可作为革兰阴性菌感的染经验性用药，含酶抑制剂类或头孢菌素可作为革兰阳性菌感染的经验性用药，常用抗生素无效的严重感染病例可酌情使用万古霉素或利奈唑胺。

Distribution and Drug Resistance of Pathogens Isolated from Children with Hematopoietic Malignances and Infection

Abstract] Objective: To investigate the characteristics and drug resistance of pathogens isolated from children with hematopoietic malignances and infection, so as to provide epidemiological data for rational application of antibiotics. Methods: A retrospective analysis was performed on the distribution characteristics and drug resistance of the pathogens isolated from children with hematopoietic malignances and infection admitted into the outpatient and inpatient department of our hospital from 2012 to 2017. Results: Totally 709 strains of pathogens were isolated from 322 children with hematopoietic malignances and infection, the most common sites of infection were blood (38.93%) and respiratory system (33.85%). The majority pathogens were gram-negative bacteria, with a total of 466 strains, mainly consisted of Klebsiella pneumoniae, Stenotrophomonas maltophilia, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and Ochrobactrum anthropi, the drug resistant rate of the main gram-negative bacteria to levofloxacin, ciprofloxacin, amikacin, piperacillin/tazobactam and imipenem (except for the Stenotrophomonas maltophilia) were relatively low. Totally 227 strains of gram-positive bacterial were isolated, mainly consisted of Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus hominis, Streptococcus pneumoniae, Staphylococcus haemolyticus, Enterococcus faecalis and Enterococcus faecium, the drug resistant rate of gram-positive bacteria to ciprofloxacin, linezolid, and vancomycin were relatively low. There were 16 strains of Candida albicans were isolated, which were sensitive to itraconazole, volconazole, fluconazole and amphotericin B. Conclusion: Children with hematological malignancies are mainly affected by respiratory system and blood infection. Carbapenems or enzyme-containing inhibitors can be used as empirical medication for gram-negative bacteria infections, enzyme inhibitors or cephalosporins can be used as empirical medication for gram-positive infections. And vancomycin or linezolid can be used for severe infections with ineffective antibiotics.