Han Q Z, Chen Y, Yang H, Zhang X F, Chen J, Wu D P, Chen S N, Qiu H Y
Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Clinical Medicine Center, Suzhou 215006, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Nov 14;38(11):930-933. doi: 10.3760/cma.j.issn.0253-2727.2017.11.005.
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 BSI. 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. 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%) . (16.0%) , (15.5%) and (11.2%) were listed the top three. The proportion of multidrug resistant and was 64.70% and 63.64% respectively, and methicillin resistant (MRSA) was more than half (57.14%) . The ratio of vancomycin resistant (VRE) and carbapenem resistant (CRE) was 14.29% and 6.78% respectively. More than 40% 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 were sensitive to vancomycin, teicoplanin and linezolid. 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 detected were resistant to vancomycin, teicoplanin and linezolid.
分析造血干细胞移植（HSCT）患者血流感染（BSI）的发生率及微生物学特征，为HSCT合并BSI患者经验性使用抗生素提供实验室依据。回顾性分析2013年至2015年期间1265例HSCT受者的血流感染发生率、血培养阳性率、细菌谱及耐药情况。1265例HSCT患者中，784例（61.98%）发生疑似BSI 1422例次，其中464例（59.2%）处于粒细胞缺乏期（中性粒细胞绝对值<0.5×10⁹/L）。2013 - 2015年病原体检出率约为20%，且逐年上升。共检出401株病原菌，其中革兰阴性（G⁻）菌221株（55.1%），革兰阳性（G⁺）菌165株（41.2%），真菌15株（3.7%）。（16.0%）、（15.5%）和（11.2%）位列前三位。多重耐药和的比例分别为64.70%和63.64%，耐甲氧西林金黄色葡萄球菌（MRSA）超过半数（57.14%）。耐万古霉素肠球菌（VRE）和耐碳青霉烯肠杆菌（CRE）的比例分别为14.29%和6.78%。超过40%的细菌对三四代头孢菌素类抗生素耐药，对碳青霉烯类抗生素耐药较少（6.4%）。然而，许多非发酵菌对这些抗生素高度耐药，且不同菌株表现出多样性，对碳青霉烯类抗生素耐药率为47.8%。所有均对万古霉素、替考拉宁和利奈唑胺敏感。HSCT患者BSI发生率高，病原菌以G⁻菌为主，除肠杆菌科细菌外，非发酵菌所占比例较高。未检出对万古霉素、替考拉宁和利奈唑胺耐药的菌株。
