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目的:了解粒细胞缺乏(中性粒细胞<0.5×109/L)的恶性肿瘤患者医院感染的病原菌分布及对抗生素的耐药情况,为临床抗感染治疗提供依据。方法:对湖南省人民医院血液肿瘤科、儿科2011年1月~2013年7月期间收治的粒细胞缺乏且合并医院感染的恶性肿瘤患者(包括血液系统恶性肿瘤)进行回顾性分析。结果:共检测出114株病原菌,其中G-杆菌81株(71.1%),G+球菌22株(19.3%),真菌11例(9.6%)。检出菌前三位分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;耐甲氧西林葡萄球菌(MRS)8株(72.7%)。产超广谱β-内酰胺酶(ESBL)大肠埃希菌和肺炎克雷伯菌分别检出6例(21.4%)和3例(21.4%)。G-杆菌对美罗培南、亚胺培南、妥布霉素、哌拉西林/他唑巴坦、米诺环素、阿米卡星耐药率均较低(≤10%),葡萄球菌对万古霉素、替考拉宁、利奈唑胺100%敏感。真菌对5-氟胞嘧啶和两性霉素B敏感性高。结论:粒细胞缺乏的恶性肿瘤患者医院感染的病原菌大多为条件致病菌,G-杆菌占大部分。该类患者极易发生医院感染,增加病原菌送检率,根据当地及本单位的病原菌分布及耐药情况合理选用抗生素,对于该类患者的抗感染治疗有积极意义。
Objective: To understand the distribution of nosocomial infections and the resistance to antibiotics in patients with neutropenia (neutrophils <0.5 × 109 / L), and to provide evidence for the clinical anti-infective therapy. Methods: A retrospective analysis was performed on patients with malignant neutropenia complicated with nosocomial infection (including hematological malignancies) admitted to Department of Hematology and Oncology, Pediatrics from January 2011 to July 2013 in Hunan Provincial People’s Hospital. Results: A total of 114 pathogens were detected, of which 81 (71.1%) were G - bacteria, 22 (19.3%) were G + cocci and 11 (9.6%) were fungi. The first three strains were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa respectively. Eight strains of methicillin-resistant Staphylococcus aureus (MRS) (72.7%) were detected. Six cases (21.4%) and three cases (21.4%) of ESBL-producing Escherichia coli and Klebsiella pneumoniae were detected respectively. The resistance rates of meropenem, imipenem, tobramycin, piperacillin / tazobactam, minocycline and amikacin to G-bacilli were lower (≤10%), Staphylococcus aureus Vancomycin, teicoplanin, linezolid 100% sensitive. Fungi is highly sensitive to 5-fluorocytosine and amphotericin B CONCLUSIONS: Most of the nosocomial pathogenic bacteria in patients with neutropenic malignancies are opportunistic pathogens, most of which are G-bacteria. Such patients prone to nosocomial infections, increase the rate of pathogenic bacteria, according to the local and the unit of the distribution of pathogens and drug resistance rational use of antibiotics, for such patients with anti-infective therapy has a positive meaning.