摘要
目的:分析多发性骨髓瘤(multiple myeloma,MM)患者的临床特征,以及并发肺部感染的病原菌分布与耐药情况,为该类患者的抗感染治疗提供参考。方法:选取2020年4月—2021年4月中牟县人民医院收治的94例MM患者的病例资料,其中并发肺部感染者63例、未并发肺部感染者31例,统计和分析患者的临床特征,以及并发肺部感染患者痰标本中病原菌的分布与主要病原菌的耐药特点。结果:MM患者在并发肺部感染时粒细胞缺乏、发热、Ⅲ期骨髓瘤、合并症的发生率明显高于未并发肺部感染的患者(P<0.05);63例并发肺部感染者痰标本中共检出病原菌68株,其中革兰阴性菌42株(占61.76%,主要为肺炎克雷伯菌、铜绿假单胞菌)、革兰阳性菌24株(占35.29%,主要为金黄色葡萄球菌、表皮葡萄球菌)和真菌2株(占2.94%);药敏结果显示,肺炎克雷伯菌、铜绿假单胞菌对亚胺培南、美罗培南的耐药率较低(<10.00%),对头孢唑林、阿莫西林、头孢曲松的耐药率较高(>80.00%);金黄色葡萄球菌、表皮葡萄球菌对万古霉素、利福平、利奈唑胺的耐药率较低(<10.00%),对氨苄西林、青霉素、四环素、红霉素的耐药率均较高(>70.00%)。结论:MM患者并发肺部感染时较易出现粒细胞缺乏、发热、Ⅲ期骨髓瘤、合并症等情况,而其病原菌主要为革兰阴性菌,临床应根据微生物培养和药敏试验结果合理选用抗菌药物,以提高抗感染治疗的准确性。
Objective:To analyze the clinical features of patients with multiple myeloma(MM),as well as the distribution and drug resistance of pathogenic bacteria in those with pulmonary infection,and provide reference for the anti-infective therapy of such patients.Methods:The case data of 94 MM patients admitted to Zhongmu County People’s Hospital from April 2020 to April 2021 were selected,including 63 patients with pulmonary infection and 31patients without pulmonary infection.The statistics and analysis of the clinical features of patients,as well as the distribution of pathogenic bacteria and drug resistance characteristics of major pathogenic bacteria in the sputum specimens of patients with concurrent pulmonary infection were conducted.Results:The incidences of agranulocytosis,fever,stageⅢmyeloma and comorbidities in MM patients with pulmonary infection were significantly higher than those without pulmonary infection(P<0.05);a total of 63 strains of pathogenic bacteria were detected in the sputum specimens of 63 patients with pulmonary infection,including 42 strains of Gram-negative bacteria(61.76%,mainly Klebsiella pneumoniae and Pseudomonas aeruginosa),24 strains of Gram-positive bacteria(35.29%,mainly Staphylococcus aureus and Staphylococcus epidermidis)and 2 strains of fungi(2.94%).The drug susceptibility test results showed that the drug resistance rates of Klebsiella pneumoniae and Pseudomonas aeruginosa to imipenem and meropenem were low(less than 10.00%),and their drug resistance rates to cefazolin,amoxicillin and ceftriaxone were high(greater than80.00%);the drug resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to vancomycin,rifampicin and linezolid were low(less than 10.00%),and their drug resistance rates to ampicillin,penicillin,tetracycline and erythromycin were high(greater than 70.00%).Conclusion:Agranulocytosis,fever,stageⅢmyeloma and comorbidities are more likely to occur in MM patients with pulmonary infection,and the pathogenic bacteria are mainly Gram-negative bacteria.Clinically,the antibacterials should be chosen rationally according to the microbial culture and drug susceptibility test results,in order to improve the accuracy of anti-infective therapy.
作者
吕根胜
LYU Gen-sheng(People's Hospital of Zhongmu,Zhengzhou 450000,China)
出处
《抗感染药学》
2022年第5期656-659,共4页
Anti-infection Pharmacy
关键词
多发性骨髓瘤
肺部感染
病原菌分布
耐药特点
multiple myeloma
pulmonary infection
distribution of pathogenic bacteria
drug resistance characteristics
