单中心血液肿瘤患儿合并感染病原菌分布及耐药性病例系列报告

doi:10.3969/j.issn.1673-5501.2019.02.007

摘要/Abstract

摘要： 目的回顾性分析血液肿瘤患儿感染病原菌的分布情况及药敏结果,为合理抗感染治疗提供依据。方法菌株来源为2016年1月1日至2017年6月30日首都医科大学附属北京儿童医院(我院)血液肿瘤中心因怀疑感染而送检、病原培养阳性且排除污染和定植的标本,分析病原菌的构成和耐药情况。药敏试验采用纸片扩散法或自动化仪器法,按照2014年美国临床实验室标准化委员会标准进行结果判定。结果 2 095例次病原学培养阳性标本中共分离到病原菌2 188株,革兰阴性菌1 053株(48.1%)、革兰阳性菌837株(38.3%)、真菌298株(13.6%)。革兰阴性菌中以肺炎克雷伯杆菌、铜绿假单胞菌、阴沟肠杆菌和大肠埃希菌为主要致病菌。革兰阳性菌以凝固酶阳性表皮葡萄球菌、人葡萄球菌和凝固酶阴性葡萄球菌多见。药敏情况:①耐甲氧西林葡萄球菌占革兰阳性菌的41.6%(348/837),以表皮葡萄球菌(84.9%,169/199)和人葡萄球菌(90.8%,129/142)为主,未检测到万古霉素、利奈唑胺和替加环素耐药菌株。②超广谱β内酰胺酶(ESBL)阳性菌占革兰阴性菌的31.9%(336/1 053),以肺炎克雷伯杆菌(63.8%,134/210)和大肠埃希菌(92.8%,90/97)为主;碳青霉烯类耐药肠杆菌科细菌占革兰阴性菌的23.6%(248/1 053),以肺炎克雷伯杆菌(63.8%,134/210)、大肠埃希杆菌(51.5%,50/97)和阴沟肠杆菌(34.5%,38/110)为主;肠杆菌科细菌对亚胺培南和美罗培南的耐药率均接近或超过50%,但对替加环素的耐药率为0.9%~13.4%,对阿米卡星的耐药率为10.0%~26.8%。③多重耐药、广泛耐药和全耐药鲍曼不动杆菌占全部鲍曼不动杆菌的32.6%(28/86)。鲍曼不动杆菌对碳青霉烯类的耐药率为52.3%~58.1%,对多黏菌素的耐药率为1.2%。结论血液肿瘤患儿合并感染以革兰阴性菌为主,耐药菌及条件致病菌检出率有增长趋势。

关键词: 病原菌, 儿童, 感染部位, 耐药菌, 血液肿瘤疾病

Abstract: Objective This study aimed to explore the pathogens and the antibiotic resistance in consecutive cases,and to provide a basis for the rational regarding antibiotic use.Methods We performed a retrospective chart review of all patients with pediatric hematology and oncology desease in Beijing Children's Hospital from January 2016 to June 2017. All patients were selected based on clinical presentation. Bacterial strains after removal of contaminated and colonized specimens were analyzed. The drug sensitivity test was determined by disk diffusion method or automatic instrument method according to the 2014 (CLSI) standard of American Clinical Laboratory Standardization Committee.Results Of all 2,188 strains isolated from 2,095 samples, 48.1% were gram-negative bacteria; 38.3% were gram-positive bacteria,and 13.6% were a fungal infection. The primary pathogens were gram-negative bacteria including Klebsiella pneumoniae,Pseudomonas aeruginosa, Enterobactercloacae, and Escherichia coli. Gram-positive bacteria were mainly coagulase-positive Staphylococcus epidermidis and human Staphylococcus. A total of methicillin-resistant Staphylococcus (MRS) gram-positive bacterial strains (41.6%,348/837) were identified, and Staphylococcus epidermidis (84.9%, 169/199) and human staphylococci (90.8%, 129/142) were the main types, but vancomycin- and linazolamide-resistant strains were not detected.Extended-spectrum β-lactamase-positive bacteria accounted for 31.9% (336/1 053)gram-negative bacteria, mainly K. pneumoniae(63.8%,134/210) and E. coli(92.8%, 90/97). As for gram-negative bacteria, there were 23.6% (248/1 053)carbapenem-resistant Enterobacteriaceae-positive bacteria, mainly K. pneumoniae(63.8%, 134/210),E. coli(51.5%, 50/97), and Enterobactercloacae(34.5%,38/110).The drug resistance rate for imipenem and meropenem was about or over 50%, but the resistance rate for tigecycline and amikacin was 0.9%-13.4% and 10%-26.8%, respectively. There were 86 Acinetobacter baumaniistrains, in which there were 32.6%(28/86) isolates drug-resistant A.baumanniistrains.The drug resistance rates of A. baumanii to carbapenem and polymyxin were 52.3%-58.1% and 1.2%.Conclusion Our report revealed a prevalence of pathogens of pediatric patients with hemato-oncological malignancies. The Gram-negative bacteria was the main pathogen. An increasing incidence of drug-resistant bacteria and opportunistic pathogens was demonstrated.

Key words: Drug-resistant bacteria, Hemato-oncological malignancies, Infection site, Pathogenic organic organismsin, Pediatric

姚佳峰, 李楠, 姜锦. 单中心血液肿瘤患儿合并感染病原菌分布及耐药性病例系列报告[J]. 中国循证儿科杂志, 2019, 14(2): 112-117.

YAO Jia-feng, LI Nan, JIANG Jin. Prevalence and drug-resisitance of pathogenic organisms in Pediatric Hematology and Oncology Department: A single center retrospective study[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(2): 112-117.

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