【摘要】：目的研究中性粒細(xì)胞缺乏(粒缺)伴發(fā)熱患者致病細(xì)菌的分布及其耐藥性現(xiàn)狀。方法回顧性分析2005年1月—2012年12月上海市第一人民醫(yī)院血液科粒缺伴發(fā)熱患者臨床分離菌的分布及藥敏特點(diǎn)。采用紙片擴(kuò)散法(K-B)進(jìn)行藥敏試驗(yàn),并按CLSI 2014年版標(biāo)準(zhǔn)判斷結(jié)果。結(jié)果共檢出粒缺伴發(fā)熱患者臨床分離菌355株,其中革蘭陽性菌占29.6%,革蘭陰性菌占70.4%。銅綠假單胞菌、肺炎克雷伯菌、鮑曼不動(dòng)桿菌、大腸埃希菌、嗜麥芽窄食單胞菌和溶血葡萄球菌分別排在所有致病菌前6位。不發(fā)酵糖革蘭陰性桿菌占革蘭陰性菌的53.2%。甲氧西林耐藥金黃色葡萄球菌(MRSA)及甲氧西林耐藥凝固酶陰性葡萄球菌(MRCNS)的檢出率均已達(dá)100%,未檢出對(duì)糖肽類和(或)唑烷酮類耐藥的葡萄球菌和腸球菌。銅綠假單胞菌對(duì)亞胺培南和美羅培南的敏感率較低,分別為40.8%和59.2%,對(duì)頭孢哌酮-舒巴坦、哌拉西林-他唑巴坦、頭孢吡肟等的敏感率大于70%。肺炎克雷伯菌對(duì)美羅培南和亞胺培南等碳青霉烯類抗生素敏感率達(dá)100%,對(duì)頭孢哌酮-舒巴坦、阿米卡星等的敏感率大于70%。鮑曼不動(dòng)桿菌對(duì)碳青霉烯類抗生素、頭孢哌酮-舒巴坦、頭孢吡肟、環(huán)丙沙星及氨基糖苷類等的敏感率均大于80%。大腸埃希菌對(duì)碳青霉烯類仍保持100%敏感,對(duì)頭孢哌酮-舒巴坦、頭孢他啶等的敏感率大于70%。嗜麥芽窄食單胞菌對(duì)左氧氟沙星、米諾環(huán)素、頭孢哌酮-舒巴坦、甲氧芐啶-磺胺甲唑的敏感率均大于90%。結(jié)論粒缺伴發(fā)熱患者致病菌以革蘭陰性菌為主,腸桿菌科細(xì)菌和不發(fā)酵糖革蘭陰性桿菌常見,耐藥情況較嚴(yán)重。葡萄球菌屬100%甲氧西林耐藥。掌握本地粒缺伴發(fā)熱致病細(xì)菌的分布及藥敏現(xiàn)狀對(duì)經(jīng)驗(yàn)性抗感染治療方案的選擇有重要的參考價(jià)值。
[Abstract]:Objective to study the distribution and drug resistance of pathogenic bacteria in patients with neutrophil deficiency and fever. Methods from January 2005 to December 2012, the distribution and drug sensitivity of clinical isolated bacteria in patients with fever in hematological department of the first people's Hospital of Shanghai were analyzed retrospectively. Drug sensitivity test was carried out by disk diffusion method (K-B), and the results were judged according to CLSI 2014 standard. Results 355 clinical isolates of Gram positive bacteria and 70.4 Gram-negative bacteria were detected. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Staphylococcus maltophilia and Staphylococcus haemolyticus ranked the top 6 respectively. Non-fermenting gram-negative bacilli accounted for 53.2% of Gram-negative bacteria. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococcus (MRCNS) were 100. No staphylococci and enterococci resistant to glycopeptide and / or azolone were detected. The sensitivity of Pseudomonas aeruginosa to imipenem and meropenem were 40.8% and 59.2% respectively. The sensitivity rates of Pseudomonas aeruginosa to cefoperazone-sulbactam piperacillin tazobactam cefepime were more than 70. The susceptibility rate of Klebsiella pneumoniae to carbapenem antibiotics such as meropenem and imipenem was 100%, and to cefoperazone-sulbactam and amikacin was more than 70%. The sensitivity of Acinetobacter baumannii to carbapenems, cefoperazone-sulbactam, cefepime, ciprofloxacin and aminoglycoside were all higher than 80%. Escherichia coli remains 100% sensitive to carbapenes, and more than 70% to cefoperazone-sulbactam, ceftazidime, etc. The sensitivity of Stenotrophomonas maltophilia to levofloxacin, minocycline, cefoperazone-sulbactam, trimethoprim-sulfamethazol was higher than 90%. Conclusion Gram-negative bacteria are the main pathogenic bacteria in patients with fever. Enterobacteriaceae and non-fermentative glycosaminoglycogram-negative bacilli are common, and drug resistance is more serious. Staphylococcus is 100% methicillin-resistant. It is important to know the distribution of pathogenic bacteria and drug sensitivity of local hypothalamus with fever for the selection of experiential anti-infective therapy.
【作者單位】： 上海交通大學(xué)附屬第一人民醫(yī)院血液科;蘇州市立醫(yī)院血液科;
【分類號(hào)】：R557.3;R446.5

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