粒细胞缺乏与非粒细胞缺乏血液病患者临床分离菌的分布及耐药性特点比较

发布时间：2018-03-14 17:05

本文选题：粒细胞缺乏　切入点：感染　出处：《临床血液学杂志(输血与检验)》2017年02期 　论文类型：期刊论文

【摘要】：目的:了解血液科合并感染的粒缺患者致病菌的分布及耐药性特点。方法:对2005-01-2012-12上海市第一人民医院血液科粒缺及非粒缺住院患者的临床分离菌株进行分析、比较,所分离的菌株均用Kirby-Bauer法进行药敏试验,并应用WHONET 5.6软件分析病原菌及药敏数据,用STATA 7软件进行统计比较。结果:来自粒缺和非粒缺患者的临床标本中分别培养分离出355株和784株细菌,粒缺患者革兰阴性菌占70.4%,高于非粒缺患者55.0%的比例(P0.01),其呼吸道分泌物标本所分离的革兰阴性菌中,不发酵糖革兰阴性杆菌所占比例高于非粒缺患者(52.9%∶30.5%,P0.01),其血流标本中大肠埃希菌的比例显著高于非粒缺患者(17.6%∶6.0%,P0.01)。粒缺患者甲氧西林耐药金黄色葡萄球菌(MRSA)及甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)的检出率均已达100%。粒缺患者分离的大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率分别为57.6%和31.9%,高于非粒缺患者(P值分别0.01和0.05)。粒缺患者分离的不发酵糖革兰阴性杆菌对碳青霉烯类药物表现出较高的耐药率,其对亚胺培南、美罗培南的耐药率分别高达42.1%和31.6%,均高于非粒缺患者(P值分别0.01和0.05)。结论:粒缺伴感染患者经验性抗感染治疗方案应根据其致病菌分布及耐药性特点来选择。
[Abstract]:Objective: to investigate the distribution and drug resistance of pathogenic bacteria in patients with granulocytosis complicated with infection in hematology department. Methods: the clinical isolates isolated from patients with or without granulocytosis in the first people's Hospital of Shanghai from January to December 2005 were analyzed and compared. The isolates were tested for drug sensitivity by Kirby-Bauer method, and the data of pathogens and drug sensitivity were analyzed by WHONET 5.6 software. Results: 355 strains and 784 strains of bacteria were isolated from clinical specimens of patients with or without granulocytosis, respectively. The proportion of Gram-negative bacteria in patients with granulocytosis was 70.4, which was higher than that in non-granulocytic patients (P 0.01). The proportion of non-fermentative glycosylGram-negative bacilli was higher than that of non-granulocytic patients (52.9% and 30.5%). The proportion of Escherichia coli in blood stream samples was significantly higher than that in non-granulocytic patients (17.6: 6.0). MRSAs and methicillin-resistant Staphylococcus aureus (MRSAs) and methicillin-resistant Staphylococcus aureus (MRSAs) in non-granulocytic deficiency patients were significantly higher than those in non-granulocytic deficiency patients. The detectable rate of coagulase negative staphylococcal staphylococci was 100. The positive rate of Escherichia coli and Klebsiella pneumoniae ESBLs strains isolated from patients with granulocytes deficiency were 57.6% and 31.9, respectively, which were higher than those of non-granulocytic patients (P value 0.01 and 0.05), respectively. The detection rates of Escherichia coli and Klebsiella pneumoniae strains were 0.05 and 0.05 respectively. The non-fermentative glycosaminoglycogram-negative bacilli showed high resistance to carbapenems. The drug resistance rates of imipenem and meropenem were as high as 42.1% and 31.6g, respectively, which were higher than those of non-granulocyte deficiency patients (P value 0.01 and 0.05). Conclusion: the empirical anti-infection treatment regimen should be selected according to the distribution of pathogenic bacteria and the characteristics of drug resistance in patients with granulocytic deficiency and infection.
【作者单位】：上海交通大学附属第一人民医院血液科;苏州市立医院血液科;
【分类号】：R446.5;R55

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