血液恶性肿瘤化疗后血流感染的病原菌分布及耐药情况分析

OBJECTIVE: To investigate the distribution and resistance of pathogens isolated from blood cultures in patients with hematological malignancies after chemotherapy in Union Hospital of Fujian Medical University so as to understand the real situation of blood stream infection (BSI) and provide the basis for rational use of antibiotics in clinic. METHODS: The data of 657 strains isolated from blood culture specimens of patients with hematological malignancies from January 2013 to December 2016 were collected analyzed. RESULTS: A total of 657 cases of blood culture positive bacterial strains were included in the study, involving 410 cases (62.4%) with single Gram-negative bacteria (G(−) bacteria), 163 cases (24.8%) with single Gram-positive bacteria (G(+) bacteria), 50 cases (7.6%) with single fungi. The most common 5 isolates in blood culture were Klebsiella pneumoniae (17.5%), Escherichia coli (17.2%), Coagulase negative staphylococci (CNS) (14.9%), Pseudomonas aeruginosa (14.2%) and Staphylococcus aureus (3.5%). The extended-spectrum beta-lactamase (ESBL) production rates of Klebsiella pneumoniae and Escherichia coli were 25.2% and 55.8%, respectively. ESBL producing strains were almost more resistant than non-ESBL producing strains. The resistance rates of Enterobacteriaceae to carbapenems, piperacillin/tazobactam and tigecycline were lower than 14.0%. The resistance rates of Pseudomonas aeruginosa to a variety of drugs were lower than 12.0%. Tigecycline-resistant Acinetobacter baumannii bacteria were not detected, and the resistance rates of Acinetobacter baumannii to cefixime and cefotaxime were 7.1%. Methicillin-resistant strains in CNS (MRCNS) and in Staphylococcus aureus (MRSA) accounted for 84.7% and 43.5%, respectively. Vancomycin, linezolid and tigecycline-resistant G(+) bacteria were not detected. CONCLUSION: The pathogens isolated from blood culture were widely distributed. Most of them were G(−) bacteria, and the resistance to antibiotics was quite common. Furhermore, vancomycin, linezolid and tigecycline can be chosen empirically to treat patiens who ar suspected to have G(+) bacterial BSI.