Zhang Peng-Peng, Wang Li-Na, Li Ming, Zhang Hao, Zhao Long, Zhang Jin, Wang Pan-Pan, Xi Ya-Ming
Department of Hematology, The First Hospital of Lanzhou University, Lnazhou 730000, Gansu Province, China.
Department of Hematology, The First Hospital of Lanzhou University, Lnazhou 730000, Gansu Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Jun;28(3):989-995. doi: 10.19746/j.cnki.issn.1009-2137.2020.03.045.
To investigate the distribution and drug resistance of nosocomial infection pathogens in AL patients with hematological agranulocytosis, so as to provide evidence for the clinical rational use of antibiotics.
Pathogenic data of 504 hospitalized patients with agranulocytosis caused by nosocomial infection in the Department of Hematology, the First Hospital of Lanzhou University from May 2015 to May 2018 were collected and retrospectively analyzed for the distribution of pathogenic bacteria and the results of drug susceptibility.
The isolated pathogenic bacteria strains amounted to 184, out of which, 168 strains (91.3%) orginated from the patients with acute leukemia, while 16 strains (8.7%) originated from the patients with non-acute leukemia. The positive samples mainly originated from blood stream, the isolated bacteria from which were 81 straims (44%); then originated from sputam and pharynx swabs, from which isolated bacteria amounted to 54 strains (29.3%) and 35 strains (19%) respectively. In the pathogenic bacteria, the Gram-negative bacteria amounted to 126 strains accounting for 68.46%, out of which the most commond bacteria strains were Klebseilla pneumoniae, cscherichia coli and Pseudomonas aeruginosa; the Gram positive bocteria amounted to 23 strains accounting for 12.5%, mainly staphy lococeus anreus, and Staphylococcus epitermidis; the fungi amounted to 35 strains accounting for 19.02%, mainly Candida albicans. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) were 40.0% and 22.2%, respectively. They were 100% sensitive to amikacin and 27.8% resistant to carbapenems. Klebsiella pneumoniae had the highest sensitivity to amikacin, 94.44% to ampicillin, 97.22% to carbapenems and 100% sensitive to ammonia. Their penicillin-resistance rate was the highest, up to 80%; Pseudomonas aeruginosa was sensitive to the antibiotics (＞80%）. Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were detected in Gram-positive bacteria. The susceptibility rate of main Gram-positive bacteria to vancomycin and linezolid was 100%, and they were 100% resistant to penicillin.
Gram-negative bacteria are the main pathogens of nosocomial infection in patients with hematological agranulocytosis. Pathogens have different resistance to antimicrobial agents. It is important to know the distribution and susceptibility of common pathogens for rational selection of antimicrobial agents and control of nosocomial infection.
探讨血液系统粒细胞缺乏症患者医院感染病原菌的分布及耐药情况，为临床合理使用抗菌药物提供依据。
收集2015年5月至2018年5月兰州大学第一医院血液科收治的504例医院感染所致粒细胞缺乏症住院患者的病原学资料，回顾性分析病原菌分布及药敏结果。
共分离出病原菌184株，其中168株（91.3%）来自急性白血病患者，16株（8.7%）来自非急性白血病患者。阳性标本主要来源于血流，分离出81株（44%）；其次为痰液和咽拭子，分别分离出54株（29.3%）和35株（19%）。病原菌中，革兰阴性菌126株，占68.46%，其中最常见的菌株为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌；革兰阳性菌23株，占12.5%，主要为金黄色葡萄球菌和表皮葡萄球菌；真菌35株，占19.02%，主要为白色念珠菌。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）的检出率分别为40.0%和22.2%。它们对阿米卡星敏感率为100%，对碳青霉烯类耐药率为27.8%。肺炎克雷伯菌对阿米卡星敏感性最高，对氨苄西林为94.44%，对碳青霉烯类为97.22%，对氨曲南为100%敏感。其对青霉素耐药率最高，达80%；铜绿假单胞菌对各抗菌药物敏感率均＞80%。革兰阳性菌中检测到耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌。主要革兰阳性菌对万古霉素和利奈唑胺敏感率为100%，对青霉素耐药率为100%。
革兰阴性菌是血液系统粒细胞缺乏症患者医院感染的主要病原菌。病原菌对抗菌药物耐药情况各异。了解常见病原菌分布及药敏情况对合理选用抗菌药物、控制医院感染具有重要意义。
