广东地区血液内科血流感染的病原菌流行病学分析

OBJECTIVE: To evaluate the epidemiology of bacterial bloodstream infections in patients submitted to hematologic wards in southern China. METHODS: A total of 50 teaching hospitals were involved based on the China Antimicrobial Resistance Surveillance System. The data of clinical isolates from blood samples were collected from January 1, 2019, to December 31, 2019. Antimicrobial susceptibility testing was conducted by the Kirby-Bauer automated systems, and the results were interpreted using the CLSI criteria. RESULTS: The data of 1,618 strains isolated from hematologic wards in 2019 were analyzed, of which gram-negative bacilli and gram-positive cocci accounted for 71.8％and 28.2％, respectively. Of those, the five major species were most often isolated, including Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, coagulase-negative staphylococcus, and Streptococcus viridans. The prevalence rates of methicillin-resistant strains in Staphylococcus aureus and coagulase-negative staphylococcus were 19.7％and 80.6％, respectively. No gram-positive cocci were resistant to vancomycin, linezolid, and teicoplanin, and none of the enterococci were resistant to linezolid. The resistance rate of S. viridans to penicillin G was 6.9％, and those to ceftriaxone and cefotaxime were more than 25％. The resistance rate of E. coli and K. pneumoniae in Enterobacteriaceae was higher in children than that in adults. The resistance rate of K. pneumoniae to meropenem was 14.1％. The resistant rate of Enterobacter cloacae to carbapenem was more than 25％. P. aeruginosa was more sensitive to more antibiotics than 80％, but the resistance rate to meropenem in children was higher than that in adults (11.8％vs. 6.5％). The proportion of gram-positive cocci in the ICU and respiratory departments was higher than that in the hematology department. The detection rates of carbapenem-resistant E. coli and K. pneumoniae in the respiratory department were the lowest with 0.3％and 3.7％, respectively, while those of CRPA and CRAB in the hematology department were the lowest with 8.3％and 25.8％, respectively. The detection rate of all carbapenem-resistant organisms in the ICU was the highest among the three departments. CONCLUSION: The etiology and drug resistance of bacteria from blood samples in the hematology department are different from those in the ICU and respiratory departments. The proportions of K. pneumoniae, P. aeruginosa, E. cloacae, and S. viridans dominating in the department of Hematology were significantly higher than those in the ICU and respiratory departments in Guangdong region.