肿瘤患者血流感染病原菌分布及耐药性分析

目的 了解肿瘤患者血流感染病原菌的分布特点及耐药情况，为临床医师经验性治疗与合理选用抗菌药物提供依据。方法 回顾性调查我院肿瘤科室2014年1月1日-2016年12月31日送检的血培养标本，对分离出的病原菌分布及其耐药性进行分析。数据统计分析采用WHONET5.6软件。结果 2291份血培养标本中，共分离出病原菌232株，阳性率为10.1%。其中，革兰阴性菌154株，占所分离病原菌的66.4%，主要为大肠埃希菌；革兰阳性菌59株，占所分离病原菌的25.4%，主要为葡萄球菌属；真菌19株，占所分离病原菌的8.2%，主要为白念珠菌和近平滑念珠菌。药敏结果提示革兰阴性菌主要对亚胺培南、美罗培南、阿米卡星和哌拉西林/三唑巴坦等敏感，对氨苄西林、氨曲南和头孢唑林等耐药率较高；革兰阳性菌主要对万古霉素和利奈唑胺等高度敏感，对青霉素、红霉素、克林霉素等耐药率较高；真菌对两性霉素B、氟胞嘧啶及伏立康唑敏感，对氟康唑的敏感性稍差。结论 我院肿瘤患者血流感染以革兰阴性菌为主，临床医师应根据病原菌药敏结果合理选用抗菌药物，降低肿瘤患者细菌耐药和真菌感染的机率，从而有效预防和控制感染，提高患者治愈率。

Analysis on the pathogenic bacteria distribution and drug resistance of blood cultures of tumor patients

Objective To study the distribution of pathogenic bacteria and drug resistance of blood cultures of tumor patients and to provide the evidence for clinical therapy and rational application of antibiotics. Methods A retrospective analysis was performed on pathogenic bacteria of blood cultures of tumor patients from January 1st, 2014 to December 31st, 2016. Data analysis was performed using the WHONET 5.6 software. Results From these 2291 blood cultures, 232 species of bacterial strains were identified with a positive rate as 10.1%. Among the 232 strains, 154 strains were Gram-negative bacilli (GNB) which were mainly attributed to Escherichia coli, 59 strains were Gram-positive cocci (GPC) which were mainly attributed to Staphylococcus species, and 19 strains were fungi which were mainly attributed to Candida albicans and Candida parapsilosis. According to drug sensitivity and resistance tests, GNB were sensitive to imipenem, meropenem, piperacillin-tazobactam and amikacin, but strongly resistant to ampicilin, aztreonam, cefazolin. GPC were sensitive to vancomycin and linezolid, but highly resistant against penicillin, clindamycin and erythromycin. Fungi were sensitive to amphotericin B, voriconazole and flucytosine, but less sensitive to fluconazole. Conclusion GNB comprised the majority of blood cultures of tumor patients. Rational use of antibiotics based on drug sensitivity tests would reduce drug resistance and fungi infections, and therefore, can effectively prevent and control