粒细胞缺乏症患者临床感染病原菌分布特征与耐药性的分层分析

发布时间：2018-01-07 15:16

本文关键词：粒细胞缺乏症患者临床感染病原菌分布特征与耐药性的分层分析　出处：《中华医院感染学杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的分析不同程度粒细胞缺乏症患者感染的病原学分布情况,为临床预防及治疗粒细胞缺乏症患者感染提供依据。方法收集医院2011年1月-2014年12月1143例粒细胞缺乏症患者临床资料,按照中性粒细胞绝对值(N×10~9/L)缺乏程度,分为轻度缺乏(0.3~0.5)组A组325例、中度缺乏(0.1~0.3)组B组421例和严重缺乏(0~0.1)组C组397例,回顾分析各组临床资料和病原学资料,统计分析比较各组差异。结果各组粒细胞缺乏症患者以41~60岁为好发年龄段;C组患者菌血症发生率显著高于A、B组(P0.05);粒细胞缺乏症患者病原菌以革兰阴性杆菌为主,占71%;大肠埃希菌,肺炎克雷伯菌及鲍曼不动杆菌在粒细胞缺乏症患者中分离率较高,其中B组患者分离的肺炎克雷伯菌显著高于A组(P0.05);C组分离的大肠埃希菌及肺炎克雷伯菌对头孢类抗菌药物的耐药率显著高于其他组,其中大肠埃希菌对头孢他啶耐药率显著高于A、B组(P0.05),肺炎克雷伯菌对头孢曲松、头孢他啶和头孢吡肟耐药率显著高于A、B组(P0.05)。结论粒细胞缺乏症患者菌血症的发生率与粒细胞缺乏程度呈正相关;病原菌以革兰阴性杆菌为主,肠杆菌科细菌为主要致病菌,严重粒细胞缺乏症患者中分离出的大肠埃希菌和肺炎克雷伯菌对头孢类抗菌药物表现出较强的耐药性。
[Abstract]:Objective to analyze the etiological distribution of granulocytosis in patients with different degrees of granulocytosis. Methods Clinical data of 1 143 patients with granulocytosis from January 2011 to December 2014 were collected. According to the degree of neutrophil absolute value N 脳 10 ~ (9 / L) deficiency, the patients were divided into two groups: group A (n = 325) and group A (n = 325). Group B (421 cases) and group C (397 cases). The clinical and etiological data of each group were analyzed retrospectively. Results the age of granulocytosis in each group was 41 ~ 60 years old. The incidence of bacteremia in group C was significantly higher than that in group A (P 0.05). Gram-negative bacilli were the main pathogenic bacteria in granulocytic deficiency patients, accounting for 71%. The isolation rates of Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii were higher in patients with granulocytosis. The resistance rate of Escherichia coli and Klebsiella pneumoniae to ceftazidime in group C was significantly higher than that in other groups, and the resistance rate of Escherichia coli to ceftazidime was significantly higher than that of group A (P0.05). The resistance rate of Klebsiella pneumoniae to ceftriaxone, ceftazidime and cefepime was significantly higher than that of group A B (P 0.05). Conclusion the incidence of bacteremia in patients with granulocytosis is positively correlated with the degree of granulocytosis. The main pathogens were Gram-negative bacilli and Enterobacteriaceae. Escherichia coli and Klebsiella pneumoniae isolated from patients with severe granulocytosis showed strong resistance to cephalosporal antibiotics.
【作者单位】：四川大学华西医院实验医学科;
【分类号】：R446.5;R55
【正文快照】： 粒细胞缺乏症常见于恶性肿瘤化疗后,此时患者处于骨髓抑制期,机体防御及免疫功能低下。中性粒细胞是机体抵抗感染的重要因素,因此粒缺病人是一类严重免疫缺陷的患者,极易发生各种感染。研究显示,恶性血液病化疗后严重中性粒细胞缺乏的患者医院感染率可高达67.4%~68.1%[1],恶性

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