2016-2017年单中心血液肿瘤患儿感染病原菌分布的临床特点分析

目的 探讨北京儿童医院血液肿瘤中心血液系统疾病患儿病原菌的流行病学特点,为临床合理使用抗菌药物提供参考依据.方法 回顾性分析2016年1月至2017年6月在北京儿童医院血液肿瘤中心住院,送检标本细菌培养阳性的血液病患儿资料.去除污染及定植标本后,共获病原菌2 188株,分析其临床资料及药敏试验结果.结果 全部病原菌中革兰阴性菌占48.1％、革兰阳性菌占38.3％、真菌占13.6％.革兰阴性菌中以肺炎克雷白杆菌、铜绿假单胞菌、阴沟肠杆菌、大肠埃希菌为主要致病菌;革兰阳性菌则以凝固酶阳性表皮葡萄球菌及人葡萄球菌为首.其中89例次标本同一部位分离出2种细菌,2例次标本同一部位分离出3种细菌.感染部位以血流(62.5％)、呼吸道(17.4％)、泌尿系统(7.2％)、皮肤软组织(6.4％)为主.1 383株血培养阳性菌株中革兰阴性菌678株(49％),革兰阳性菌631株(45.6％),真菌74株(5.4％).呼吸道、泌尿系感染病原以革兰阴性菌为主,而皮肤软组织的感染病原以革兰阳性菌为主.革兰阳性菌中,共检出耐甲氧西林葡萄球菌(methicillin-resistant staphylococcus,MRS)348株(占革兰阳性菌的41.6％),以表皮葡萄球菌及人葡萄球菌为主;革兰阴性菌中检测到超广谱β内酰胺酶(extended-spectmmbeta-lactamase,ESBL)阳性的细菌336株(占革兰阴性菌的31.9％),以肺炎克雷伯杆菌及大肠埃希菌为主.结论 血液肿瘤患儿合并感染以革兰阴性菌为主,血流及呼吸道为最常见的感染部位,耐药菌及条件致病菌发生率有增长趋势.

Prevalence and features of pathogenic bacteria in the Department of Pediatric Hematology and Oncology:a single-center experience from 2016 to 2017

Objective To explore the incidence,pathogens and clinical features of infection in consecutive cases,as well as the common sites of infection.Methods All pediatric patients who had blood disease accompanied by infection in our hospital from January 2016 to June 2017 were retrospectively reviewed.Removal of contaminated and colonized specimens,there were 2 188 bacterial strains for analysis.The basic clinical characteristics,blood culture results,and antimicrobial susceptibilities were analyzed.Results There were Gram-negative bacteria (48.1％),Gram-positive bacteria (38.3％) and fungus (13.6％).The primary pathogens were Klebsiella pneumoniae,pseudomonas aeruginosa,enterobacter cloacae and Escherichia coli in Gram-negative bacteria.Gram-positive bacteria were mainly coagulase-positive Staphylococcus epidermidis and human staphylococcus.Two pathogens were isolated from 89 samples and three pathogens were isolated from 2 samples.The mainly sites of infection were the blood infection (62.5％),respiratory tract (17.4％),urinary system (7.2％),skin soft tissue (6.4％).Of the 1 383 positive blood culture strains,Gram-negative bacteria occupied 49％,Gram-positive bacteria 45.6％ and fungus 5.4％.Gram-negative bacteria were the main pathogens of respiratory tract and urinary tract infection,but Gram-positive bacteria were the main pathogens in skin and soft tissue.A total of 348 strains (41.6％) of methicillin-resistant Staphylococcus (MRS) were identified in Gram-positive bacteria,in which mainly were Staphylococcus epidermidis and staphylococcus human.336 strains (31.9％) of extended-spectrum β-lactamase (ESBL) positive bacteria were detected in Gram-negative bacteria,mainly Klebsiella pneumoniae and Escherichia coli.Conclusion Gram-negative bacteria are the main pathogenic bacteria in patients with blood disease in our center.Blood infection and respiratory tract infection are the most common infection sites.The incidence of drug-resistant bacteria and opportunistic pathogens have an increasing trend.