恶性肿瘤患者医院感染的病原菌的分布特征及耐药性调查

目的:了解引起恶性肿瘤患者医院感染的病原菌及耐药性,为临床合理治疗提供理论依据.方法:用常规方法对2002年1月～2004年12月因恶性肿瘤在中山大学附属二院住院的患者的各种临床标本进行培养、分离,用API及VIKET2进行细菌鉴定,K-B法进行药物敏感性试验检测,WHONET5软件对结果进行分析.结果:(1)引起恶性肿瘤患者医院感染的病原菌主要是革兰阴性杆菌(G-B),占50.2%(132/263),其次是真菌22.8%(60/263)、革兰阳性球菌(G C)27.0%(71/263);G-B中又以大肠埃希菌(Ecoli)27.3%(36/132)、铜绿假单胞菌23.5%(31/132)、克雷伯菌17.4%(23/132)为主,其中产超广谱β-内酰胺酶(ESBLs)的发生率为45.8%(27/59);G C主要是葡萄球菌66.2%(47/71),肠球菌18.3%(13/71),其中耐甲氧西林的葡萄球菌(MRS)78.7%(37/47)、甲氧西林敏感的葡萄球菌(MSS)21.3%(10/47);真菌以白色念球菌为主81.6%(49/60).(2)G-B对所检测的抗菌素耐药率最低的是亚胺培南0.0%～9.7%(嗜麦芽窄食单胞菌除外),其次头孢匹肟5.6%～60.0%、头孢他啶5.6%～40.0%;G C耐药率最低的是万古霉素(0.0%),其他的抗生素均呈现不同程度的耐药性,未发现耐万古霉素的葡萄球菌及肠球菌.结论:引起恶性肿瘤患者医院感染的病原菌主要是真菌、葡萄球菌、Ecoli、铜绿假单胞菌等条件致病菌,亚胺培南、万古霉素分别是治疗G-B、G C感染的首选药物.

Distribution Characteristic and Resistance of Pathogens Causing Hospital Infection from Malignant Tumor Patients

Objective: To study the pathogens which causing hospital infection from patients with malignant tumor and their resistance, in order to provide the theory evidences for doctors when they cure with antibiotics reasonable. Methods: All species were isolated by routine methods from the clinical specimens which from patients with malignant tumor in our hospital during January 2002 to December 2004,and identified by API or VIKET2,the susceptibility test were detected by K - B method, the data were numerated with the whonet5 software. Results: (1)The main pathogens causing hospital infection in malignant tumor patients was Gram - negative bacilli(G-B), had 50.2% (132/263) .After, fungus had 22.8% (60/263),Gram-positive coccus (G+C),had 27.0% (71/263); inG-B, E coli was 27.3%(36/132),Pseudomonas was 23.5%(31/132), Klebsiella was 17.4%(23/132), the occurrence of ESBLs was 45.8%(27/59); In G+C, Staphylococcus was 66.2% (47/71), Enterococcus was 18.3% (13/71) .In them, meticllin - resistant Staphylococcus was 78.7% (37/47) and meticllin - sensitive Staphylococcus was 21.3% (10/47); The main fungus was Calbicans, account for 81.6% (49/ 60) .(2) The resistant rate of G-B to the Imipenem(IMP) was the lowest(0.0%-9.7%) in antibiotics tested(except of Xanthomonas maltophilia), and then Ceftazidime(CAZ) 5.6%-60.0%, Cefepime(FEP) 5.6%-40.0%. The resistant rate of G+ C to the Vancomycin was the lowest(0.0% ),the other antibiotics had different resistance. No Staphylococcus and Enterococcus were resistance to Vancomycin. Conclusion: Theniain pathogens which causing hospilal infection in malignanttumorpatientsaretheconditionedpathogenicbacteria, such as fungus, Staphylococcus, E coli and Pseudomonas. Irnipenemand Vancomycin respectively was the best drug forG-BandG+C.