上海地区粒细胞缺乏伴肺部感染血液病患者呼吸道分离细菌及耐药性多中心回顾性研究

目的 了解上海地区中性粒细胞缺乏（粒缺）伴肺部感染血液病患者呼吸道分泌物检出病原菌的分布及耐药情况。方法 回顾性收集2012年1月—2014年12月上海市12所医院血液科粒缺伴肺部感染住院患者呼吸道分泌物分离菌株的临床资料、药敏结果，分析病原菌分布及其药敏数据，比较不同原发疾病病原菌分布之间的差异。结果 共分离病原菌623株，其中革兰阳性菌138株（22.2%），革兰阴性菌485株（77.8%），非发酵菌占革兰阴性菌的60.2%（292株）。淋巴瘤患者标本中分离革兰阳性菌构成比（35.0%）高于急性髓系白血病和急性淋巴细胞白血病患者。居前5位的细菌分别是嗜麦芽窄食单胞菌（104株，16.7%）、肺炎克雷伯菌（88株，14.1%）、鲍曼不动杆菌（62株，10.0%）、铜绿假单胞菌（56株，9.0%）、金黄色葡萄球菌（48株，7.7%）。肺炎克雷伯菌对碳青霉烯类抗生素敏感率>98%，铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为24.3%、8.9%，嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素、复方磺胺甲口恶唑敏感率>90%，鲍曼不动杆菌对阿米卡星、头孢哌酮/舒巴坦的耐药率低于10%。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为71.4%，未发现耐万古霉素、替考拉宁、利奈唑胺的金黄色葡萄球菌。结论 粒缺伴肺部感染患者呼吸道分泌物分离菌株以革兰阴性菌占多数，其中非发酵菌占50%以上，细菌耐药率整体低于CHINET全国医院大样本监测结果。

A multicenter retrospective study on isolation and drug resistance of pathogens isolated from respiratory tract in hematological patients with agranulocytosis accompanied by pulmonary infection in Shanghai

Objective To investigate the distribution and drug resistance of pathogens isolated from respiratory secretion of hematological patients with agranulocytosis accompanied by pulmonary infection in Shanghai. Methods Clinical data and drug susceptibility result of bacteria isolated from respiratory secretion of hospitalized patients with agranulocytosis and pulmonary infection in departments of hematology in 12 hospitals of Shanghai between January 2012 and December 2014 were retrospectively collected, distribution of pathogenic bacteria and drug susceptibility data were analyzed, difference among pathogenic bacteria in different primary diseases was compared. Results A total of 623 strains of pathogenic bacteria were isolated, 138 (22.2%) of which were gram-positive bacteria, 485 (77.8%) were gram-negative bacteria, 60.2% of (292 strains) gram-negative bacteria were non-fermentative bacteria. Constituent ratio of gram-positive bacteria isolated from patients with lymphoma (35.0%) was higher than patients with acute myeloid leukemia and acute lymphoblastic leukemia. The top five bacteria were Stenotrophomonas maltophilia (104 strains, 16.7%), Klebsiella pneumoniae (88 strains, 14.1%), Acinetobacter baumannii (62 strains, 10.0%), Pseudomonas aeruginosa (56 strains, 9.0%) and Staphylococcus aureus (48 strains, 7.7%). Susceptibility rate of Klebsiella pneumoniae to carbapenems was>98%, resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 24.3% and 8.9% respectively, susceptibility rate of Stenotrophomonas maltophilia to levofloxacin, minocycline and compound sulfamethoxazole was more than 90%, resistance rate of Acinetobacter baumannii to amikacin, cefoperazone/sulbactam was less than 10%. Isolation rate of methicillin-resistant Staphylococcus aureus was 71.4%, no vancomycin-resistant, teicoplanin-resistant and linezolid-resistant Staphylococcus aureus were found. Conclusion Gram-negative bacteria accounts for the majority of isolates from respiratory secretion of patients with agranulocytosis and pulmonary infection, non-fermentative bacteria accounted for more than 50%, the overall bacterial resistance rate is lower than that of CHINET nationwide large sample surveillance.