發(fā)布時間：2018-01-06 06:01

  本文關鍵詞：血液科細菌感染的病原學及臨床特點分析　出處：《安徽醫(yī)科大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 血液病 細菌 感染 耐藥性 造血干細胞移植

【摘要】：目的分析2010-2014年安徽省立醫(yī)院血液科住院患者不同病區(qū)細菌感染的病原菌分布特點、抗菌藥物敏感及耐藥情況;同時對分析同期接受造血干細胞移植患者早期感染的病源學和臨床特點,探討細菌感染與移植類別、移植物抗宿主病、移植早期死亡的關系。方法收集2010年1月至2014年12月我院血液科住院患者所有臨床標本分離菌株,采用Kirby-Bauer紙片擴散法和自動化儀器法進行藥敏試驗,試驗結果運用WHONET5.6軟件進行細菌菌株及耐藥性分析;同期回顧性分析我科造血干細胞移植患者早期細菌感染的病原學特點及耐藥性變遷,運用IBM SPSS17.0軟件對臨床數(shù)據(jù)進行統(tǒng)計分析。結果2010年1月至2014年12月血液科臨床送檢標本3312份,其中培養(yǎng)陽性的標本為634份,陽性率19.14%;血液陽性標本488份,其次為痰液標本。陽性標本中革蘭陽性菌株為207份,占32.65%,主要為凝固酶陰性葡萄球菌、鏈球菌及腸球菌。革蘭陰性菌株427份,占67.35%,是臨床主要的病原菌,其中大腸桿菌、肺炎克雷伯桿菌、銅綠假單胞菌列前3位;非發(fā)酵菌株呈逐年緩慢增長趨勢。抗菌藥物敏感試驗的結果:大腸桿菌及肺炎克雷伯桿菌對亞胺培南、哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦、阿米卡星的耐藥率分別為0.8%、13.7%、17.1%、12.9%及11.8%、11.8%、33.3%、8.8%,對頭孢菌素類耐藥率在41.2-86.7%。超廣譜β內(nèi)酰胺酶(ESBLs)在大腸桿菌及肺炎克雷伯桿菌中的檢出率分別為83.9%及75%。銅綠假單胞菌對亞胺培南的耐藥率為3.3%,對頭孢他啶及哌拉西林/他唑巴坦耐藥率均為6.7%,對頭孢哌酮/舒巴坦耐藥率為0。鮑曼不動桿菌對亞胺培南的耐藥率為18.2%,對頭孢哌酮/舒巴坦耐藥率為0。金黃色葡萄球菌及凝固酶陰性的葡萄球菌對青霉素G的耐藥性分別為100%及87.5%,而耐甲氧西林的金黃色葡萄球菌(MRSA)及耐甲氧西林的凝固酶陰性的葡萄球菌檢出率分別為20%及65.9%;屎腸球菌對氟喹諾酮類藥物耐藥率在96.2-100%。未檢測出對萬古霉素、利奈唑胺、替加環(huán)素耐藥的葡萄球菌及腸球菌,其敏感率均為100%。同期414在我科進行造血干細胞移植的患者中104例患者分離培養(yǎng)出113份陽性菌株,感染率25.12%,其中革蘭氏陰性菌占75.22%,主要為大腸桿菌,產(chǎn)ESBLs菌株占84.3%,耐藥率高達94.12%;而G+菌僅占28.32%,其中凝固酶陰性葡萄球菌及屎腸球菌均為敏感菌株。33例患者因感染死亡,死亡率為7.47%。非血緣臍血移植的患者細菌感染率及致死率均高于外干/骨髓移植的患者(χ2=26.998,P0.01)vs(χ2=9.129,P=0.003),臍血移植后造血重建延遲是導致感染率增加的重要因素(t=16.292,P0.01);但與是否為清髓性預處理方案及急性移植物抗宿主病的發(fā)生無統(tǒng)計學差異。結論血液科細菌感染發(fā)生率較高,病原菌以革蘭氏陰性菌為主,造血干細胞移植患者耐藥菌株感染逐漸增多。本研究對于血液病患者合并細菌感染的經(jīng)驗性治療及造血干細胞移植后感染并發(fā)癥的防治具有一定的參考價值。
[Abstract]:Objective to analyze the distribution characteristics of bacterial infection, antimicrobial susceptibility and drug resistance of patients in Department of Hematology of Anhui Provincial Hospital from 2010 to 2014. At the same time, the pathogeny and clinical characteristics of early infection in patients receiving hematopoietic stem cell transplantation were analyzed, and the types of bacterial infection and transplantation, graft-versus-host disease were discussed. Methods from January 2010 to December 2014, all clinical specimens of patients in our hospital were collected. The drug sensitivity test was carried out by Kirby-Bauer disk diffusion method and automatic instrument method. The results were analyzed by WHONET5.6 software. The etiological characteristics and drug resistance of early bacterial infection in patients with hematopoietic stem cell transplantation (HSCT) were analyzed retrospectively. IBM SPSS17.0 software was used to analyze the clinical data. Results from January 2010 to December 2014, 3 312 clinical samples were collected in hematology department. Among them, 634 samples were positive in culture, the positive rate was 19.14%. There were 488 positive blood samples, followed by sputum samples. Among the positive specimens, 207 were Gram-positive strains, accounting for 32.65staphylococci, mainly coagulase-negative staphylococci. There were 427 strains of streptococcus and Enterococcus, accounting for 67.35.It was the main pathogenic bacteria in clinic, among which Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa ranked first 3; The results of antimicrobial susceptibility test showed that Escherichia coli and Klebsiella pneumoniae were resistant to imipenem, piperacillin / tazobactam, cefoperazone / sulbactam. The drug resistance rates of amikacin were 0.8% and 12.9% and 11.8%, respectively. The resistance rate to cephalosporins was 41.2-86.7. Extended-spectrum 尾 -lactamases ESBLs). The detectable rates in Escherichia coli and Klebsiella pneumoniae were 83.9% and 75.The resistance rate of Pseudomonas aeruginosa to imipenem was 3.3%. The resistance rates to ceftazidime and piperacillin / tazobactam were both 6.7, and to cefoperazone / sulbactam were 0. The resistance rate of Acinetobacter baumannii to imipenem was 18.2%. The resistance rate to cefoperazone / sulbactam was 0. The resistance of Staphylococcus aureus and coagulase-negative staphylococcus to penicillin G were 100% and 87.5% respectively. The positive rates of methicillin-resistant staphylococcus aureus and methicillin-resistant coagulase negative staphylococcus were 20% and 65.9, respectively. The resistance rate of Enterococcus faecium to fluoroquinolones was 96.2-100. No vancomycin, linazolamide, tegacycline resistant staphylococcus and enterococcus were detected. The sensitivity rates were 100. In the same period, 113 positive strains were isolated from 104 patients undergoing hematopoietic stem cell transplantation in our department, and the infection rate was 25.12%. Gram-negative bacteria accounted for 75.22, mainly Escherichia coli, ESBLs producing strains accounted for 84.3 and the drug resistance rate was 94.12; Among them, coagulase negative Staphylococcus and Enterococcus faecium were sensitive strains. 33 patients died of infection. The mortality was 7.47%. The bacterial infection rate and mortality rate of non-blood cord blood transplantation patients were higher than those of external stem / bone marrow transplantation patients (蠂 2 = 26.998). P0.01V / s (蠂 ~ 2 / 9.129 / P ~ (0.003)). Delayed hematopoietic reconstitution after umbilical cord blood transplantation was an important factor leading to the increase of infection rate. However, there was no significant difference in the incidence of acute graft-versus-host disease and myeloablative pretreatment. Conclusion the incidence of bacterial infection in hematology is higher, and Gram-negative bacteria are the main pathogens. The infection of drug-resistant strains in patients with hematopoietic stem cell transplantation increased gradually. This study has a certain reference value for the empirical treatment of hematologic patients with bacterial infection and the prevention and treatment of complications of infection after hematopoietic stem cell transplantation.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R446.5;R457.7

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