目的 探討天津醫(yī)科大學(xué)腫瘤醫(yī)院惡性腫瘤患者血流感染病原菌分布及耐藥情況，為臨床合理用藥提供理論依據(jù)。方法 對(duì)2015—2019年天津醫(yī)科大學(xué)腫瘤醫(yī)院血培養(yǎng)結(jié)果進(jìn)行回顧性分析。結(jié)果 2015年1月—2019年12月天津醫(yī)科大學(xué)腫瘤醫(yī)院經(jīng)血培養(yǎng)分離出菌株1 471株，在科室分布方面，肝膽胰腺腫瘤科、胃腸腫瘤科、血液腫瘤科占比均超過(guò)10%；在病原菌分布方面，革蘭陰性菌占67.7%；革蘭陽(yáng)性菌占28.1%；真菌占4.1%。革蘭陰性菌以大腸埃希菌、肺炎克雷伯菌、陰溝腸桿菌為主；革蘭陽(yáng)性菌中，以金黃色葡萄球菌、表皮葡萄球菌、糞腸球菌、屎腸球菌為主；在耐藥性方面，碳青霉烯類、哌拉西林他唑巴坦、氟喹諾酮類、阿米卡星對(duì)主要腸桿菌科細(xì)菌保持良好的敏感性。葡萄球菌屬中，表皮葡萄球菌中甲氧西林耐藥菌株檢出率高于金黃色葡萄球菌，表皮葡萄球菌整體耐藥率高于金黃色葡萄球菌。腸球菌屬中，屎腸球菌的整體耐藥率高于糞腸球菌。結(jié)論 天津醫(yī)科大學(xué)腫瘤醫(yī)院腫瘤患者血流感染的病原菌以革蘭陰性菌為主，與其他腫瘤醫(yī)院報(bào)道一致。耐藥率低于2019年CHINET三甲醫(yī)院細(xì)菌耐藥監(jiān)測(cè)數(shù)據(jù)。

Objective To investigate the distribution and drug resistance of pathogens causing bloodstream infections in patients with malignant tumor in Cancer Hospital of Tianjin Medical University, and to provide theoretical basis for clinical rational drug use. Methods The blood culture results of Cancer Hospital of Tianjin Medical University from 2015 to 2019 were retrospectively analyzed. Results From January 2015 to December 2019, 1 471 strains of bacteria were isolated by blood culture in Cancer Hospital of Tianjin Medical University. In terms of department distribution, hepatobiliary and pancreatic oncology, gastrointestinal oncology, and hematology oncology accounted for more than 10%. In terms of pathogen distribution, gram-negative bacteria accounted for 67.7%, gram-positive bacteria 28.1%, and fungi 4.1%. Gram negative bacteria were mainly Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae; gram positive bacteria were mainly Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis and Enterococcus faecium. In terms of drug resistance, carbapenems, piperacillin tazobactam, fluoroquinolones and amikacin maintained good sensitivity to the main Enterobacteriaceae. Among Staphylococcus, the detection rate of methicillin resistant Staphylococcus epidermidis was higher than that of Staphylococcus aureus, and the overall resistance rate of Staphylococcus epidermidis was higher than that of Staphylococcus aureus. The overall resistance rate of Enterococcus faecium was higher than that of Enterococcus faecalis. Conclusion Gram negative bacteria are the main pathogens of bloodstream infection in cancer patients in Cancer Hospital of Tianjin Medical University, which is consistent with other cancer hospitals. The drug resistance rate was lower than the monitoring data of bacterial resistance in the top three hospitals of Chinet in 2019.

R978.1

國(guó)家自然科學(xué)基金項(xiàng)目資助項(xiàng)目（81703454）