Che M T, Wang C M, Liu H F, Kong H, Li L J, Song J, Wang H Q, Wang Y G, Wu G J, Guan J, Xing W, Qu L M, Liu H, Wang X M, Hu Z D, Shao Z H, Fu R
Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, China.
Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin 300052, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Oct 14;45(10):937-943. doi: 10.3760/cma.j.cn121090-20240603-00201.
To analyze the distribution and drug resistance of pathogens of bacterial bloodstream infection in patients with hematological diseases in the Department of Hematology of Tianjin Medical University General Hospital, and to provide etiological data for clinical empirical anti-infection treatment. A retrospective analysis was conducted on the general clinical information, pathogenic bacteria and drug susceptibility test results of patients with hematological diseases diagnosed with bacterial bloodstream infection by menstrual blood culture in our center from January 2016 to December 2022. Patients included 498 inpatients, with a total of 639 bacterial strains. Among the patients, 86.9% patients had malignancies, and 76.7% had agranulocytosis. Symptoms of concurrent infections, including those of the respiratory tract, oral mucosa, skin and soft tissues, and abdominal sources were observed in 68.3% patients. Gram-negative bacteria (G(-)) accounted for 79.0% of the isolated bacteria, and gram-positive bacteria (G(+)) accounted for 21.0%. The top five isolated pathogens were Klebsiella pneumoniae (22.5%), Escherichia coli (20.8%), Pseudomonas aeruginosa (15.0%), Enterococcus faecium (5.5%), and Stenotrophomonas maltophilum (5.0%). Escherichia coli exhibited a decreasing trend of resistance to quinolones, cephalosporins, and carbapenems. Klebsiella pneumoniae exhibited increasing rates of resistance to quinolones and cephalosporins between 2016 and 2018, but the rated decreased after 2019. The resistance rate to carbapenems exhibited by Pseudomonas aeruginosa was approximately 20%. Carbapenem-resistant strains of Pseudomonas aeruginosa strains were first detected in 2017, with a peak resistance rate of 35.7%, detected in 2019. A 60.0% resistance rate to methicillin was observed in methicillin-resistant coagulase-negative staphylococci (MRCNS), and one case of linezolid-resistant MRCNS was detected. Pathogenic bacteria of bacterial bloodstream infections were widely distributed in our center, and precautions are warranted against carbapenem resistant P. aeruginosa and Klebsiella pneumoniae.
分析天津医科大学总医院血液科血液系统疾病患者细菌血流感染病原菌的分布及耐药情况，为临床经验性抗感染治疗提供病原学依据。回顾性分析2016年1月至2022年12月在我院经血培养确诊为细菌血流感染的血液系统疾病患者的一般临床资料、病原菌及药敏试验结果。患者包括498例住院患者，共分离出639株细菌。患者中，86.9%为恶性肿瘤患者，76.7%有粒细胞缺乏症。68.3%的患者出现并发感染症状，包括呼吸道、口腔黏膜、皮肤及软组织和腹部感染源。革兰阴性菌（G(-)）占分离菌的79.0%，革兰阳性菌（G(+)）占21.0%。分离出的前五位病原菌依次为肺炎克雷伯菌（22.5%）、大肠埃希菌（20.8%）、铜绿假单胞菌（15.0%）、粪肠球菌（5.5%）和嗜麦芽窄食单胞菌（5.0%）。大肠埃希菌对喹诺酮类、头孢菌素类和碳青霉烯类药物的耐药率呈下降趋势。肺炎克雷伯菌在2016年至2018年间对喹诺酮类和头孢菌素类药物的耐药率呈上升趋势，但2019年后有所下降。铜绿假单胞菌对碳青霉烯类药物的耐药率约为20%。2017年首次检测到耐碳青霉烯类铜绿假单胞菌菌株，2019年耐药率达到峰值35.7%。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）对甲氧西林的耐药率为60.0%，检测到1例耐利奈唑胺的MRCNS。我院细菌血流感染病原菌分布广泛，需警惕耐碳青霉烯类铜绿假单胞菌和肺炎克雷伯菌。
