目的 分析肇庆市第一人民医院2017年1月-2021年12月肿瘤科和血液肿瘤科血培养的病原菌分布和药敏情况,以了解临床血流感染状况,为临床合理使用抗菌药物提供依据。方法 收集2017年1月1日-2021年12月31日肇庆市第一人民医院肿瘤科和血液肿瘤科临床送检血培养阳性标本分离出的210株病原菌资料并对患者临床资料进行分析。结果 210株血培养阳性菌株中,血液肿瘤92株,实体肿瘤118株。革兰阴性杆菌136株(占64.76%),革兰阳性球菌66株(占31.43%),真菌8株(占3.81%)。前5位的致病细菌分别为大肠埃希菌(24.29%)、凝固酶阴性葡萄球菌(15.24%)、肺炎克雷伯菌(12.86%)、铜绿假单胞菌(12.38%)、金黄色葡萄球菌(9.05%)。革兰阴性杆菌中大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBL)菌株的检出率分别为37.2%、19%。其中铜绿假单胞菌对亚胺培南的耐药率为15%,对美罗培南的耐药率为15.8%。结论 肇庆市第一人民医院恶性肿瘤患者化疗后合并血流感染病原菌种类分布较广,以革兰阴性杆菌为主,耐药情况较严峻。临床上对怀疑有革兰阳性球菌血液感染患者可经验性选择万古霉素、利奈唑胺或替加环素抗感染治疗。

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