中国医学科学院学报

高级检索
中国医学科学院学报

中国医学科学院学报 ›› 2014, Vol. 36 ›› Issue (4): 439-445.doi: 10.3881/j.issn.1000-503X.2014.04.016

• 论著 • 上一篇    下一篇

2010至2012年北京协和医院单中心血液科非移植病房细菌感染病原菌分布及临床特点分析

王璐1,杨辰1,张倩1,韩冰1,庄俊玲1,陈苗1,邹农1,李剑1,段明辉1,张薇1,朱铁楠1,许莹1,王书杰1,周道斌1,赵永强1,张辉2,王澎2,徐英春2   

  1. 中国医学科学院 北京协和医学院 北京协和医院 1血液科 2细菌室,北京 100730
  • 收稿日期:2014-01-03 出版日期:2014-08-31 发布日期:2014-08-31
  • 通讯作者: 韩冰 电话:010-69155024,电子邮件:hanbing_li@sina.com.cn
  • 基金资助:
    国家自然科学基金(81201873,81241073),北京市自然科学基金(7132050)和北京大学“985工程”(临床医院合作专项)建设项目

Prevalence and Features of Pathogenic Bacteria in the Department of Hematology without Bone Marrow Transplantation in Peking Union Medical College Hospital from 2010 to 2012

WANG Lu1,YANG Chen1,ZHANG Qian1,HAN Bing1,ZHUANG Jun-ling1,CHEN Miao1,ZOU Nong1,LI Jian1,DUAN Ming-hui1,ZHANG Wei1,ZHU Tie-nan1,XU Ying1,WANG Shu-jie1,ZHOU Dao-bin1,ZHAO Yong-qiang1,ZHANG Hui2,WANG Peng2,XU Ying-chun2   

  1. 1Department of Hematology,2Department of Clinical Bacteriology Laboratory,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2014-01-03 Online:2014-08-31 Published:2014-08-31
  • Contact: HAN Bing Tel:010-69155024,E-mail:hanbing_ li@sina.com.cn
  • Supported by:
    Supported by the National Natural Sciences Foundation of China (81201873,81241073),the Natural Sciences Foundation of Beijing,China (7132050),and “985 Project” of Peking University (Clinical Hospital Cooperation Project) Construction Project,China

摘要: 目的 探讨近3年北京协和医院血液科患者细菌的流行病学及临床特点。方法 回顾性分析2010至2012年北京协和医院血液科病房所有送检的标本中具有阳性细菌培养结果的患者的资料,了解感染的病原菌分布、部位、疾病状态、治疗反应及转归。结果 共检出阳性致病细菌388例次,占所有送检标本的5.8%。其中社区感染占8.4%,以革兰阴性菌为主(75%),无耐药菌出现。院内感染占91.6%,最常见的感染部位为呼吸道(49.4%)、血流(32.6%)、皮肤软组织(10.4%)及泌尿系(3.7%),病原菌分布以革兰阴性菌为主(66.9%),最多见的革兰阴性菌为大肠埃希菌(13.8%)、铜绿假单胞菌(12.1%)及肺炎克雷伯菌(12.1%),最多见的革兰阳性菌为金黄色葡萄球菌(10.4%)、屎肠球菌(7.0%)及表皮葡萄球菌(5.1%)。呼吸道、血流感染菌以革兰阴性菌为主,皮肤创面及肛周软组织感染则以革兰阳性菌感染为主。在革兰阳性菌和革兰阴性菌中,均出现了较高比例的耐药菌。多数患者(68.1%)处于粒细胞缺乏及免疫抑制状态。22例(71.9%)患者经治疗后感染得到有效控制。感染相关死亡者42例(13.6%)。共检出定植菌61例次,以嗜麦芽窄食单胞菌及鲍曼不动杆菌等非发酵菌多见。结论 血液病患者院内感染以革兰阴性菌为主,肺部感染及血流感染为最常见的感染部位,不同感染部位的病原菌种类分布不同,目前抗感染治疗后多数患者可得到有效控制,但仍有较高的感染相关死亡率,非发酵菌需鉴别定植菌及致病菌。

关键词: 细菌感染, 血液系统疾病, 院内感染, 革兰阴性菌, 革兰阳性菌, 药敏

Abstract: Objective To investigate the incidence,pathogens,and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital. Method The incidence,pathogen,treatment,and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed. Results There were 449 positive samples (5.8%) from 4 890 patients during this period,among which 388 were proved to be with pathogenic bacteria. Samples separated from patients with community-aquired infections accounted for 8.4% of all positive samples. Most community-aquired infections were caused by Gram-negative bacteria (75%),although no multidrug-resistant bacteria was observed. Samples separated from patients with nosocomial infections accounted for 91.6% of all positive samples. Respiratory tract (49.4%) and peripheral blood (32.6%) were the most common samples with positive results. Skin soft tissues (10.4%),and urine (3.7%) were less common samples. Most of the pathogenic bacteria of the nosocomial infections were Gram-negative (66.9%). The most common Gram-negative bacteria included Escherichia coli (13.8%),Pseudomonas aeruginosa (12.1%),and Klebsiella pneumonia (12.1%),while Staphylococcus aureus (10.4%),Enterococcus faecium (7.0%),and Staphylococcus epidermidis (5.1%) were the most common Gram-positive bacteria. Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples. Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria (63.8%). The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca,Escherichia coli,and Proteus mirabilis were 24.0%,87.9% and 38.4%,respectively. The resistance to Acinetobacter baumannii was serious. Multidrug-resistant,extensive drug resistant and pan drug resistant A. baumannii acountted for 74% of all A. Baumannii infections. Stenotrophomonas maltophilia showed low resistance to sulfamethoxazole/trimethoprim,levofloxacin and minocycline. Also,22 methicillin-resistant Staphylococcus aureus and 9 methicillin-resistant Staphylococcus Epidermidis were detected,which were only sensitive to vancomycin,teicoplanin,and linezolid. All patients were treated in the haematology wards and most of them were under agranulocytosis or immunosuppression. Finally,22 patients reached clinical recovery through anti-infective therapy,whereas 49 patients died. Among those deaths,42 patients attributed to severe infections and infection-associated complications. Fourteen of all the deaths might be infected with drug-resistance bacteria. There were 61 samples proved to be bacteria colonization. Nonfermenters such as Acinetobacter baumannii and Stenotrophomonas maltophilia made up for a large amount of bacteria colonization. Conclusions The pathogens of nosocomial infections in the hematology ward are mainly Gram-negative bacteria. The incidences and pathogens vary from different infection sites. Nosocomial infection still has a higher mortality rate. Once nonfermenters are detected positive,the pathogenic or colonial bacteria should be distinguished.

Key words: bacterial infection, hematological disease, nosocomial infection, Gram-negative bacteria, Gram-positive bacteria, drug resistance

中图分类号: