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目的探讨和分析恶性血液病患者发生病原菌感染时细菌的分布特点及耐药情况,为临床合理应用抗菌药物提供一定的科学依据。方法选取我院2000年1月至2014年1月收治的血液病发生细菌感染并由标本培养出病原菌株的患者130例为研究对象,对病原菌分布和用药情况进行系统性回顾分析,观察和统计细菌的分布情况和耐药特点。结果恶性血液病患者病原菌感染部位以血流感染为主(85例,占64.5%),所有病原菌中以革兰阴性菌为主(90株,占69.2%),其次为革兰阳性菌(68株,占21.6%);耐药性统计中,各类细菌耐药性明显,大肠埃希菌对ESBLs检出率为90.3%,肺炎克雷伯菌对ESBLs检出率为62.9%,葡萄球菌中检出MRSA 4株和MRCNS 5株。革兰阴性杆菌对亚胺培南、阿米卡星、美罗培南较敏感,耐药率较低;革兰阳性菌对万古霉素、利福平、莫西沙星和替加西林较敏感,耐药率低。头孢类抗生素已不适合一线用药。结论恶性血液病患者病原菌分布以血流感染为主,主要为革兰阴性菌,病原菌对各类抗菌药物耐药性严重,应根据细菌分布和耐药特点合理应用抗菌药物。
Objective To investigate and analyze the distribution and drug resistance of bacteria in the pathogenesis of pathogenic bacteria infection in patients with hematologic malignancies and provide some scientific evidences for the rational use of antibacterial drugs in clinic. Methods A total of 130 patients with bacterial infections caused by blood diseases and pathogenic strains were collected from January 2000 to January 2014 in our hospital were selected as the research objects. The distribution and medication of pathogens were systematically reviewed and observed. Statistics and statistics Bacterial distribution and drug resistance characteristics. Results Hepatic infection was the main pathogen in 85 cases (64.5%) of the patients with hematologic malignancies. Gram-negative bacteria was dominant in all pathogens (90 strains, accounting for 69.2%), followed by Gram-positive bacteria Strain accounted for 21.6%). In drug resistance statistics, the resistance of all kinds of bacteria was obvious. The detection rate of ESBLs by Escherichia coli was 90.3%. The detection rate of ESBLs by Klebsiella pneumoniae was 62.9% Four strains of MRSA and five strains of MRCNS were detected. Gram-negative bacilli were more sensitive to imipenem, amikacin and meropenem, with lower resistance rate. Gram-positive bacteria were more sensitive to vancomycin, rifampicin, moxifloxacin and tegacicillin, Low drug rates. Cephalosporins antibiotics are not suitable for first-line medication. Conclusions The distribution of pathogenic bacteria in patients with hematologic malignancies is mainly bloodstream infection, mainly Gram-negative bacteria. The pathogenic bacteria have serious resistance to all kinds of anti-bacterial drugs. Antibacterial drugs should be rationally applied according to the characteristics of bacterial distribution and drug resistance.