摘要
目的分析造血干细胞移植（HSCT）患者血流感染的发生率、病原菌分布及药敏情况，为临床血流感染的经验性治疗提供依据。方法对2013-2015年在苏州大学附属第一医院行HSCT的1265例患者进行血流感染发生率、血培养阳性率、病原菌种类和耐药情况分析。结果1265例HSCT患者中，有784例（61．98％）共发生1422例次血流感染，464例（59．2％）患者处于粒细胞缺乏期（ANC〈0．5×10^9／L）。2013-2015年病原菌检出率逐年上升，总体为20．07％。检出的401株病原菌中，革兰阴性菌221株（55．1％），革兰阳性菌165株（41．2％），真菌15株（3．7％）。排名前三位为大肠埃希菌（16．O％）、表皮葡萄球菌（15．5％）和肺炎克雷伯菌（11．2％）；细菌耐药情况严峻，多重耐药的鲍曼不动杆菌和嗜麦芽窄食单胞菌比例分别为64．70％与63．64％，耐甲氧西林金黄色葡萄球菌（MRSA）比例为57．14％，均超过50．0％。耐万古霉素肠球菌（VRE）与耐碳青霉烯类抗生素肠杆菌科细菌（CRE）比例分别为14．29％、6．78％。革兰阴性菌中肠杆菌科细菌对三、四代头孢类药物耐药率较高，对碳青霉烯类抗生素耐药率较低（6．4％）。非发酵菌对抗菌药物耐药情况差别较大，对碳青霉烯类抗生素耐药率较高（47．8％）；葡萄球菌属菌株对万古霉素、替考拉宁和利奈唑胺的敏感率均为100．0％。结论HSCT患者血流感染发生率较高，病原菌仍以革兰阴性菌为主，非发酵菌的占比也较高，未检测到对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。
Objective To analyze the incidence and microbiological features of blood stream infections （BSI） of patients with hematopoietic stem cell transplantation （HSCT） and to provide laboratory data for empirical use of antibiotic for the HSCT patients with BSL Methods The incidence of bloodstream infection, the positive rate of blood culture, bacterial spectrum and drug resistance were analyzed in 1 265 HSCT recipients during 2013 and 2015 were retrospectively studied. Results Of 1265 patients undergoing HSCT, 1 422 cases of suspected BSI occurred in 784 patients （61.98%）, and 464 patients （ 59.2% ） were in the stage of agranulocytosis （ANC 〈 0.5×10^9/L）. The detection rate of pathogens in 2013-2015 was about 20% and increase year after year. Of the 401 strains detected, 221 were Gram-negative（G-） bacteria （55.1%）, 165 Gram-positive （G＇）bacteria （41.2%） and 15 fungi（3.7%）. Escherichia coli （ 16.0% ）, Staphylococcus epidermidis （ 15.5% ） and Klebsiella pneumoniae （ 11.2% ） were listed the top three. The proportion of multidrug resistant Acinetobacter Bauman and Stenotrophomonas maltophilia was 64.70% and 63.64% respectively, and methicillin resistant Staphylococcus aureus（MRSA） was more than half （57.14%）. The ratio of vancomycin resistant Enterococci （VRE） and carbapenem resistant Enterobacteriaceae （CRE） was 14.29% and 6.78% respectively. More than 40% Enterobacteriaceae bacteria were resistant to three or four generation cephalosporin antibiotics, and less were resistant to the carbapenems （6.4%）. However, many non-fermentating bacteria were highly resistant to these antibiotics and showed diversity among different strains, with a rate of 47.8% resistance to carbapenems. All the Staphylococcus were sensitive to vancomycin, teicoplanin and linezolid. Conclusions The incidence of BSI in patients with HSCT was high, and the pathogens were mainly G- bacteria. In addition to Enterobacteriaceae, the proportion of non-fermentative bacteria was quite high. No Staphylococcus detected were resistant to vancomycin, teicoplanin and linezolid.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2017年第11期930-933,共4页
Chinese Journal of Hematology
基金
国家自然科学基金青年基金（81501425）
苏州市“科教兴卫”青年科技项目（kjxw2014008）
关键词
造血干细胞移植
血流感染
抗药性
Hematopoietic stem cell transplantation
Blood stream infection
Drug resistance
