血液科细菌感染的病原学及临床特点分析

发布时间：2018-01-06 06:01

本文关键词：血液科细菌感染的病原学及临床特点分析　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的分析2010-2014年安徽省立医院血液科住院患者不同病区细菌感染的病原菌分布特点、抗菌药物敏感及耐药情况;同时对分析同期接受造血干细胞移植患者早期感染的病源学和临床特点,探讨细菌感染与移植类别、移植物抗宿主病、移植早期死亡的关系。方法收集2010年1月至2014年12月我院血液科住院患者所有临床标本分离菌株,采用Kirby-Bauer纸片扩散法和自动化仪器法进行药敏试验,试验结果运用WHONET5.6软件进行细菌菌株及耐药性分析;同期回顾性分析我科造血干细胞移植患者早期细菌感染的病原学特点及耐药性变迁,运用IBM SPSS17.0软件对临床数据进行统计分析。结果2010年1月至2014年12月血液科临床送检标本3312份,其中培养阳性的标本为634份,阳性率19.14%;血液阳性标本488份,其次为痰液标本。阳性标本中革兰阳性菌株为207份,占32.65%,主要为凝固酶阴性葡萄球菌、链球菌及肠球菌。革兰阴性菌株427份,占67.35%,是临床主要的病原菌,其中大肠杆菌、肺炎克雷伯杆菌、铜绿假单胞菌列前3位;非发酵菌株呈逐年缓慢增长趋势。抗菌药物敏感试验的结果:大肠杆菌及肺炎克雷伯杆菌对亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星的耐药率分别为0.8%、13.7%、17.1%、12.9%及11.8%、11.8%、33.3%、8.8%,对头孢菌素类耐药率在41.2-86.7%。超广谱β内酰胺酶(ESBLs)在大肠杆菌及肺炎克雷伯杆菌中的检出率分别为83.9%及75%。铜绿假单胞菌对亚胺培南的耐药率为3.3%,对头孢他啶及哌拉西林/他唑巴坦耐药率均为6.7%,对头孢哌酮/舒巴坦耐药率为0。鲍曼不动杆菌对亚胺培南的耐药率为18.2%,对头孢哌酮/舒巴坦耐药率为0。金黄色葡萄球菌及凝固酶阴性的葡萄球菌对青霉素G的耐药性分别为100%及87.5%,而耐甲氧西林的金黄色葡萄球菌(MRSA)及耐甲氧西林的凝固酶阴性的葡萄球菌检出率分别为20%及65.9%;屎肠球菌对氟喹诺酮类药物耐药率在96.2-100%。未检测出对万古霉素、利奈唑胺、替加环素耐药的葡萄球菌及肠球菌,其敏感率均为100%。同期414在我科进行造血干细胞移植的患者中104例患者分离培养出113份阳性菌株,感染率25.12%,其中革兰氏阴性菌占75.22%,主要为大肠杆菌,产ESBLs菌株占84.3%,耐药率高达94.12%;而G+菌仅占28.32%,其中凝固酶阴性葡萄球菌及屎肠球菌均为敏感菌株。33例患者因感染死亡,死亡率为7.47%。非血缘脐血移植的患者细菌感染率及致死率均高于外干/骨髓移植的患者(χ2=26.998,P0.01)vs(χ2=9.129,P=0.003),脐血移植后造血重建延迟是导致感染率增加的重要因素(t=16.292,P0.01);但与是否为清髓性预处理方案及急性移植物抗宿主病的发生无统计学差异。结论血液科细菌感染发生率较高,病原菌以革兰氏阴性菌为主,造血干细胞移植患者耐药菌株感染逐渐增多。本研究对于血液病患者合并细菌感染的经验性治疗及造血干细胞移植后感染并发症的防治具有一定的参考价值。
[Abstract]:Objective to analyze the distribution characteristics of bacterial infection, antimicrobial susceptibility and drug resistance of patients in Department of Hematology of Anhui Provincial Hospital from 2010 to 2014. At the same time, the pathogeny and clinical characteristics of early infection in patients receiving hematopoietic stem cell transplantation were analyzed, and the types of bacterial infection and transplantation, graft-versus-host disease were discussed. Methods from January 2010 to December 2014, all clinical specimens of patients in our hospital were collected. The drug sensitivity test was carried out by Kirby-Bauer disk diffusion method and automatic instrument method. The results were analyzed by WHONET5.6 software. The etiological characteristics and drug resistance of early bacterial infection in patients with hematopoietic stem cell transplantation (HSCT) were analyzed retrospectively. IBM SPSS17.0 software was used to analyze the clinical data. Results from January 2010 to December 2014, 3 312 clinical samples were collected in hematology department. Among them, 634 samples were positive in culture, the positive rate was 19.14%. There were 488 positive blood samples, followed by sputum samples. Among the positive specimens, 207 were Gram-positive strains, accounting for 32.65staphylococci, mainly coagulase-negative staphylococci. There were 427 strains of streptococcus and Enterococcus, accounting for 67.35.It was the main pathogenic bacteria in clinic, among which Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa ranked first 3; The results of antimicrobial susceptibility test showed that Escherichia coli and Klebsiella pneumoniae were resistant to imipenem, piperacillin / tazobactam, cefoperazone / sulbactam. The drug resistance rates of amikacin were 0.8% and 12.9% and 11.8%, respectively. The resistance rate to cephalosporins was 41.2-86.7. Extended-spectrum 尾 -lactamases ESBLs). The detectable rates in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.The resistance rate of Pseudomonas aeruginosa to imipenem was 3.3%. The resistance rates to ceftazidime and piperacillin / tazobactam were both 6.7, and to cefoperazone / sulbactam were 0. The resistance rate of Acinetobacter baumannii to imipenem was 18.2%. The resistance rate to cefoperazone / sulbactam was 0. The resistance of Staphylococcus aureus and coagulase-negative staphylococcus to penicillin G were 100% and 87.5% respectively. The positive rates of methicillin-resistant staphylococcus aureus and methicillin-resistant coagulase negative staphylococcus were 20% and 65.9, respectively. The resistance rate of Enterococcus faecium to fluoroquinolones was 96.2-100. No vancomycin, linazolamide, tegacycline resistant staphylococcus and enterococcus were detected. The sensitivity rates were 100. In the same period, 113 positive strains were isolated from 104 patients undergoing hematopoietic stem cell transplantation in our department, and the infection rate was 25.12%. Gram-negative bacteria accounted for 75.22, mainly Escherichia coli, ESBLs producing strains accounted for 84.3 and the drug resistance rate was 94.12; Among them, coagulase negative Staphylococcus and Enterococcus faecium were sensitive strains. 33 patients died of infection. The mortality was 7.47%. The bacterial infection rate and mortality rate of non-blood cord blood transplantation patients were higher than those of external stem / bone marrow transplantation patients (蠂 2 = 26.998). P0.01V / s (蠂 ~ 2 / 9.129 / P ~ (0.003)). Delayed hematopoietic reconstitution after umbilical cord blood transplantation was an important factor leading to the increase of infection rate. However, there was no significant difference in the incidence of acute graft-versus-host disease and myeloablative pretreatment. Conclusion the incidence of bacterial infection in hematology is higher, and Gram-negative bacteria are the main pathogens. The infection of drug-resistant strains in patients with hematopoietic stem cell transplantation increased gradually. This study has a certain reference value for the empirical treatment of hematologic patients with bacterial infection and the prevention and treatment of complications of infection after hematopoietic stem cell transplantation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5;R457.7

【参考文献】