目的 分析肇慶市第一人民醫(yī)院2017年1月-2021年12月腫瘤科和血液腫瘤科血培養(yǎng)的病原菌分布和藥敏情況,以了解臨床血流感染狀況,為臨床合理使用抗菌藥物提供依據(jù)。方法 收集2017年1月1日-2021年12月31日肇慶市第一人民醫(yī)院腫瘤科和血液腫瘤科臨床送檢血培養(yǎng)陽性標(biāo)本分離出的210株病原菌資料并對患者臨床資料進(jìn)行分析。結(jié)果 210株血培養(yǎng)陽性菌株中,血液腫瘤92株,實體腫瘤118株。革蘭陰性桿菌136株(占64.76%),革蘭陽性球菌66株(占31.43%),真菌8株(占3.81%)。前5位的致病細(xì)菌分別為大腸埃希菌(24.29%)、凝固酶陰性葡萄球菌(15.24%)、肺炎克雷伯菌(12.86%)、銅綠假單胞菌(12.38%)、金黃色葡萄球菌(9.05%)。革蘭陰性桿菌中大腸埃希菌和肺炎克雷伯菌產(chǎn)超廣譜β內(nèi)酰胺酶(ESBL)菌株的檢出率分別為37.2%、19%。其中銅綠假單胞菌對亞胺培南的耐藥率為15%,對美羅培南的耐藥率為15.8%。結(jié)論 肇慶市第一人民醫(yī)院惡性腫瘤患者化療后合并血流感染病原菌種類分布較廣,以革蘭陰性桿菌為主,耐藥情況較嚴(yán)峻。臨床上對懷疑有革蘭陽性球菌血液感染患者可經(jīng)驗性選擇萬古霉素、利奈唑胺或替加環(huán)素抗感染治療。

Objective To investigate the distribution and resistance of pathogens isolated from blood cultures in patients with cancer after chemotherapy in Zhaoqing First People’s Hospital from January 2017 to December 2021, so as to understand the situation of blood stream infection, and provide the basis for rational use of antibiotics in clinic. Methods The data of 210 strains isolated from blood culture specimens of patients with cancer from January 1, 2017 to December 31, 2021 were collected analyzed. Results A total of 210 cases of blood culture positive bacterial strains were included in the study, involving 92 cases hematological malignancies and 118 cases solid tumor. There were 136 cases (64.76%) single gram-negative bacteria and 66 cases (31.43%) single gram-positive bacteria, 8 cases (3.81%) with single fungi. The most common 5 isolates in blood culture were Escherichia coli (24.29%), coagulase negative Staphylococci (15.24%), Klebsiella pneumonia (12.86%), Pseudomonas aeruginosa (12.38%) and Staphylococcus aureus (9.05%). ESBL production rates of Escherichia coli and Klebsiella pneumoniae were 37.2% and 19%. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 15% and 15.8%. 84.4% of coagulase-negative staphylococcus were methicillin-resistant coagulase-negative Staphylococcus (MRCNS). 42.1% of Staphylococcus aureus was methicillin-resistant Staphylococcus aureus (MRSA). No gram-positive bacteria were found to be resistant to vancomycin, linezolid, and tigecycline. Conclusion In the Zhaoqing First People's Hospital, malignant tumor patients complicated with bloodstream infection after chemotherapy had a wide distribution of pathogenic bacteria, mainly gram-negative bacteria, with severe drug resistance. Clinically, patients suspected of blood infection with gram-positive cocci can be empirically treated with vancomycin, linezolid or tegecycline.

R979.1