Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
BMC Infect Dis. 2022 Feb 10;22(1):146. doi: 10.1186/s12879-022-07114-x.
Infections are the main cause of death in patients with hematologic malignancies. This study aims to determine the microbial profile of infections in patients with hematologic malignancies and to determine the antimicrobial resistance patterns for these pathogens.
A retrospective descriptive cross-sectional study was conducted from January 2018 to December 2019 at a large hematological center in Palestine. The medical data of hematologic malignancy patients with positive cultures were collected from the hematology/oncology department using the hospital information system, and data regarding the microbial isolates and their antimicrobial resistance were collected from the microbiology laboratory.
A total of 144 isolates were identified from different types of specimens, mostly blood samples. Of all isolates, 66 (45.8%) were gram-negative bacteria (GNB), 57 (39.6%) were gram-positive bacteria (GPB), and 21 (14.6%) were fungal isolates. The GNB that were most frequently isolated were Pseudomonas aeruginosa (27, 40.9%), followed by Escherichia coli (E. coli) (20, 30.3%). Fourteen isolates (24.6%) of GPB were Staphylococcus epidermidis followed by Enterococcus faecium (10, 17.5%) and Staphylococcus hemolyticus (10, 17.5%). The most frequent fungal pathogens were Candida species (20, 95.2%). GNB were found to be resistant to most antibiotics, mainly ampicillin (79.3%). Pseudomonas aeruginosa exhibited high resistance to ciprofloxacin (60%) and imipenem (59.3%). Among GPB, high resistance rates to oxacillin (91.1%) and amikacin (88.8%) were found. All isolated strains of Staphylococcus epidermidis were resistant to cephalosporins and oxacillin. Approximately half of the GNB isolates (34, 51.5%) were multi-drug resistant organisms (MDRO), and 16.7% (11 isolates) were difficult-to-treat resistance (DTR). Furthermore, 68.4% (39 isolates) of GPB were MDRO. The proportion of staphylococci (CoNS and S. aureus) resistant to oxacillin was 91.7%, while 88.6% of enterococci were resistant to vancomycin.
The findings of this study confirm the predominant microorganisms seen in patients with hematologic malignancies, and show a high percentage of antibiotic resistance. Policies regarding antibiotic use and proper infection control measures are needed to avert the ever-growing danger of antimicrobial resistance. This may be achieved by developing antibiotic stewardship programs and local guidelines based on the hospital's antibiogram.
感染是血液恶性肿瘤患者死亡的主要原因。本研究旨在确定血液恶性肿瘤患者感染的微生物谱，并确定这些病原体的抗菌药物耐药模式。
这是一项回顾性描述性的横断面研究，于 2018 年 1 月至 2019 年 12 月在巴勒斯坦的一个大型血液中心进行。使用医院信息系统从血液科/肿瘤科收集血液恶性肿瘤患者阳性培养物的医学数据，并从微生物实验室收集有关微生物分离株及其抗菌药物耐药性的数据。
从不同类型的标本中总共鉴定出 144 株分离株，主要是血液样本。在所有分离株中，革兰氏阴性菌（GNB）为 66 株（45.8%），革兰氏阳性菌（GPB）为 57 株（39.6%），真菌分离株为 21 株（14.6%）。最常分离的革兰氏阴性菌是铜绿假单胞菌（27，40.9%），其次是大肠杆菌（E. coli）（20，30.3%）。革兰氏阳性菌中，表皮葡萄球菌（14，24.6%）分离株最多，其次是屎肠球菌（10，17.5%）和溶血葡萄球菌（10，17.5%）。最常见的真菌病原体是念珠菌属（20，95.2%）。发现革兰氏阴性菌对大多数抗生素具有耐药性，主要是氨苄西林（79.3%）。铜绿假单胞菌对环丙沙星（60%）和亚胺培南（59.3%）表现出高耐药性。在革兰氏阳性菌中，发现对苯唑西林（91.1%）和阿米卡星（88.8%）的耐药率较高。所有分离的表皮葡萄球菌株均对头孢菌素和苯唑西林耐药。约一半的革兰氏阴性菌分离株（34 株，51.5%）为多药耐药菌（MDRO），16.7%（11 株）为难治性耐药菌（DTR）。此外，68.4%（39 株）的革兰氏阳性菌为 MDRO。耐苯唑西林的葡萄球菌（凝固酶阴性葡萄球菌和金黄色葡萄球菌）的比例为 91.7%，而耐万古霉素的肠球菌比例为 88.6%。
本研究的结果证实了血液恶性肿瘤患者中常见的微生物，并且显示出很高的抗生素耐药率。需要制定抗生素使用政策和适当的感染控制措施，以避免抗菌药物耐药性不断增长的威胁。这可以通过制定抗生素管理计划和基于医院药敏试验结果的本地指南来实现。
