本文選題：粒細胞缺乏　切入點：感染　出處：《臨床血液學(xué)雜志(輸血與檢驗)》2017年02期 　論文類型：期刊論文

【摘要】：目的:了解血液科合并感染的粒缺患者致病菌的分布及耐藥性特點。方法:對2005-01-2012-12上海市第一人民醫(yī)院血液科粒缺及非粒缺住院患者的臨床分離菌株進行分析、比較,所分離的菌株均用Kirby-Bauer法進行藥敏試驗,并應(yīng)用WHONET 5.6軟件分析病原菌及藥敏數(shù)據(jù),用STATA 7軟件進行統(tǒng)計比較。結(jié)果:來自粒缺和非粒缺患者的臨床標本中分別培養(yǎng)分離出355株和784株細菌,粒缺患者革蘭陰性菌占70.4%,高于非粒缺患者55.0%的比例(P0.01),其呼吸道分泌物標本所分離的革蘭陰性菌中,不發(fā)酵糖革蘭陰性桿菌所占比例高于非粒缺患者(52.9%∶30.5%,P0.01),其血流標本中大腸埃希菌的比例顯著高于非粒缺患者(17.6%∶6.0%,P0.01)。粒缺患者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100%。粒缺患者分離的大腸埃希菌和肺炎克雷伯菌產(chǎn)ESBLs菌株的檢出率分別為57.6%和31.9%,高于非粒缺患者(P值分別0.01和0.05)。粒缺患者分離的不發(fā)酵糖革蘭陰性桿菌對碳青霉烯類藥物表現(xiàn)出較高的耐藥率,其對亞胺培南、美羅培南的耐藥率分別高達42.1%和31.6%,均高于非粒缺患者(P值分別0.01和0.05)。結(jié)論:粒缺伴感染患者經(jīng)驗性抗感染治療方案應(yīng)根據(jù)其致病菌分布及耐藥性特點來選擇。
[Abstract]:Objective: to investigate the distribution and drug resistance of pathogenic bacteria in patients with granulocytosis complicated with infection in hematology department. Methods: the clinical isolates isolated from patients with or without granulocytosis in the first people's Hospital of Shanghai from January to December 2005 were analyzed and compared. The isolates were tested for drug sensitivity by Kirby-Bauer method, and the data of pathogens and drug sensitivity were analyzed by WHONET 5.6 software. Results: 355 strains and 784 strains of bacteria were isolated from clinical specimens of patients with or without granulocytosis, respectively. The proportion of Gram-negative bacteria in patients with granulocytosis was 70.4, which was higher than that in non-granulocytic patients (P 0.01). The proportion of non-fermentative glycosylGram-negative bacilli was higher than that of non-granulocytic patients (52.9% and 30.5%). The proportion of Escherichia coli in blood stream samples was significantly higher than that in non-granulocytic patients (17.6: 6.0). MRSAs and methicillin-resistant Staphylococcus aureus (MRSAs) and methicillin-resistant Staphylococcus aureus (MRSAs) in non-granulocytic deficiency patients were significantly higher than those in non-granulocytic deficiency patients. The detectable rate of coagulase negative staphylococcal staphylococci was 100. The positive rate of Escherichia coli and Klebsiella pneumoniae ESBLs strains isolated from patients with granulocytes deficiency were 57.6% and 31.9, respectively, which were higher than those of non-granulocytic patients (P value 0.01 and 0.05), respectively. The detection rates of Escherichia coli and Klebsiella pneumoniae strains were 0.05 and 0.05 respectively. The non-fermentative glycosaminoglycogram-negative bacilli showed high resistance to carbapenems. The drug resistance rates of imipenem and meropenem were as high as 42.1% and 31.6g, respectively, which were higher than those of non-granulocyte deficiency patients (P value 0.01 and 0.05). Conclusion: the empirical anti-infection treatment regimen should be selected according to the distribution of pathogenic bacteria and the characteristics of drug resistance in patients with granulocytic deficiency and infection.
【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】：R446.5;R55

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