急性白血病患者血流感染的病原菌分布特点及耐药分析

目的探讨引起急性白血病患者血流感染的病原菌分布特点以及分析其耐药情况。 方法选择于2013年1月至2015年12月本院就诊并被诊断为急性白血病患者共100例，分析其血培养阳性结果，分析细菌种类和其药敏试验结果。 结果100株致病菌中，真菌2株（2%），革兰阳性菌（G⁺菌）35株（占35%），革兰阴性菌（G^-菌）63株（占63%）。G⁺菌中以葡萄球菌最多（30株，占30%）；G^-菌以肠杆菌科细菌最多（53株，占53%）。葡萄球菌中，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占36.7%（11/30）；肠杆菌科细菌中，产超广谱β-内酰胺酶（ESBLs）肠杆菌科细菌占17.31%（9/52）。对两种及两种以上抗菌药物耐药菌有92株，占总致病菌的92%。G^-菌对氨苄西林/舒巴坦、头孢曲松、头孢唑林、复方磺胺甲噁唑以及氨曲南等耐药率较高，G⁺菌对青霉素、克林霉素、阿奇霉素以及红霉素等耐药率较高。 结论血流感染的病原菌种类较多，耐药率较高，治疗G^-菌感染，头孢哌酮/舒巴坦、美罗培南、亚胺培南和哌拉西林/他唑巴坦等作为临床用药选择；治疗G⁺菌感染，左氧氟沙星、利奈唑胺和万古霉素等可作为临床经验性用药选择。

Distribution of pathogenic bacteria and the drug resistance in bloodstream infections of patients with acute leukemia

ObjectiveTo investigate the distribution of pathogenic bacteria and the drug resistance in bloodstream infections of patients with acute leukemia. MethodsTotal of 100 patients with acute leukemia from our hospital were collected from January 2013 to December 2015, and the positive results of blood culture were analyzed. And the bacterial species and their drug susceptibility were analyzed. ResultsAmong the 100 strains of pathogenic bacteria, there were 2 strains (2%) of fungus, 35 strains of Gram-positive (G⁺) bacteria (35%) and 63 strains of Gram-negative (G^-) bacteria (63%). Among the 35 strains of G⁺ bacteria, the main bacteria was Staphylococcus aureus, accounting for 30%. Among 63 strains of G^- bacteria, the main bacteria was Enterobacteriaceae, accounting for 53%. Among Staphylococcus aureus, methicillin-resistant coagulase negative Staphylococcus (MRCNS) accounted for 36.7% (11/30). Among Enterobacteriaceae, extended-spectrum β-lactamases (ESBLs) accounted for 17.31% (9/52). There were 92 strains of ntibiotic resistant bacteria which resisted to two or more kinds of antibiotic, accounting for 92%. The rate of G^- bacteria resisted to ampicillin/sulbactam, ceftriaxone, cefazolin, compound sulfamethoxazole and aztreonam were relatively higher, while the rates of G⁺ bacteria resisted to penicillin, clindamycin, azithromycin and erythromycin were relatively higher. ConclusionsThe species of pathogenic bacteria were various and their rates of resistance were higher. For treating G^-bacterial infection, cefoperazone/sulbactam, meropenem, imipenem, piperacillin/tazobactam could be clinical choices. For the treatment of G⁺ bacterial infection, levofloxacin, linezolid and vancomycin could be taken.