CAJ | 학술논문

目的：分析血液病患者发生血流感染的病原菌分布情况及耐药性，为临床合理使用抗菌药物、有效控制感染提供可靠依据。方法回顾分析64例血流感染患者临床资料，了解其临床特点、血流感染病原菌种类及药敏情况。结果64例血流感染患者送检的272份血液标本中共培养出77株（28．30％）病原菌，其中G-菌60株（占77．92％）、G＋菌14株（占18．18％）、真菌3株（3．90％），1例患者发生混合细菌感染。分离的病原菌中，主要为大肠埃希菌（41．55％）、肺炎克雷伯菌（12．99％）、凝固酶阴性葡萄球菌（11．69％）、金黄色葡萄球菌属（3．90％）。产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌、肺炎克雷伯菌检出率分别为71．88％和50．00％；耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为33．33％和88．88％。G-菌对美罗培南、哌拉西林-他唑巴坦、阿米卡星耐药率低，葡萄球菌对万古霉素、利奈唑胺、利福平耐药率低。结论引起血液病患者出现血流感染的主要致病菌为G-菌，对G-菌及G＋菌最敏感的药物分别为美罗培南及万古霉素、利奈唑胺，建议选用抗G-菌为主、兼顾G＋菌的抗菌药物进行经验性治疗，必要时加用抗真菌药物。
목적：분석혈액병환자발생혈류감염적병원균분포정황급내약성，위림상합리사용항균약물、유효공제감염제공가고의거。방법회고분석64례혈류감염환자림상자료，료해기림상특점、혈류감염병원균충류급약민정황。결과64례혈류감염환자송검적272빈혈액표본중공배양출77주（28．30％）병원균，기중G-균60주（점77．92％）、G＋균14주（점18．18％）、진균3주（3．90％），1례환자발생혼합세균감염。분리적병원균중，주요위대장애희균（41．55％）、폐염극뢰백균（12．99％）、응고매음성포도구균（11．69％）、금황색포도구균속（3．90％）。산초엄보β-내선알매（ESBLs）적대장애희균、폐염극뢰백균검출솔분별위71．88％화50．00％；내갑양서림금황색포도구균（MRSA）화내갑양서림응고매음성포도구균（MRCNS）적검출솔분별위33．33％화88．88％。G-균대미라배남、고랍서림-타서파탄、아미잡성내약솔저，포도구균대만고매소、리내서알、리복평내약솔저。결론인기혈액병환자출현혈류감염적주요치병균위G-균，대G-균급G＋균최민감적약물분별위미라배남급만고매소、리내서알，건의선용항G-균위주、겸고G＋균적항균약물진행경험성치료，필요시가용항진균약물。
Objective To study the distribution and drug resistance of blood stream infection(BSI)in hematologic patients,so as to guide the clinical use of antibiotics.Methods Sixty-four BSI patients hospitalized from Jan 2010 to Oct 2013 were enrolled to perform retro-spective analysis on clinic data in order to understand the clinical features,the bacterial identification and drug sensitivity.Results All pa-tients had fever,and 74.03%had infection lesions,mostly in lungs.A total of 77 strains(28.30%)of pathogenic bacteria were isolated,inclu-ding 60 gram-negative (77.92%),14 gram-positive (18.18%)and 3 fungi(3.90%).Mixed infection was found in 1 patient.The isolated pathogenic bacteria were mainly Escherichia coli (41.55%),klebsiella pneumonia (12.99%),coagulase-negative staphylococci (11.69%) and staphylococci aureus(3.90%).The detection rates of Escherichia coli and klebsiella pneumonia producing super spectrum βlactamases (ESBLs)were 71.88% and 50.00%,respectively;those of methicillin resistant S aureus (MRSA)and meticillin resistant coagulase-nega-tive staphylococcus(MRCNS)were 33.33% and 88.88%,respectively.Gram-negative bacilli were relatively susceptible to meropenem,pip-eracillin-tazobactam and amikacin.Staphylococcus isolates were susceptible to vancomycin,linezolid and rifampicin.Conclusion The patho-genic bacteria inducing BSI are mainly gram negative,especially the Escherichia coli,bacteria.For G+and G-bacteria,meropenem and van-comycin linezolid are the most sensitive drugs respectively.It is suggested that empirical treatment of antimicrobial agents like anti G-bacteria and G+bacteria should be used,and antifungal drugs should be added when necessary.