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目的了解恶性血液病与实体瘤化疗合并败血症细菌学类型、体外抗生素的敏感性及其变化规律,为临床经验使用抗生素提供参考。方法合并发热住院的肿瘤病人124例,其中恶性血液病96例,实体瘤28例。在使用抗生素前常规做血培养、体外分离细菌菌株并测定对抗生素的敏感性。结果单份血标本,培养阳性率为18.7%,一次抽2份血标本,培养阳性率为30.6%,两者差异具有显著性(P<0.05)。感染菌种G-菌19例(52.8%),G+菌16例(44.4%),白色念株菌1例(2.8%)。常见的致病菌为大肠埃希菌、葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌。2004年葡萄球菌、肠球菌感染有上升趋向。体外药敏试验显示耐药菌株增加,主要是针对头孢类、喹诺酮类抗生素耐药。结论连续2次以上的血标本能明显提高血培养的阳性率。恶性血液病与实体瘤化疗患者主要感染的是内源性细菌,以G-菌为主,G+菌感染和耐药菌株有上升趋势,其原因与不合理使用广谱抗生素及医院交叉感染有关。
Objective To understand the bacteriological types of malignant hematological diseases and solid tumors with chemotherapy and sepsis, the sensitivity and variation of antibiotics in vitro, and provide a reference for the clinical experience of using antibiotics. Methods Totally 124 patients with fever were hospitalized, including 96 cases of hematologic malignancies and 28 solid tumors. Blood cultures were routinely performed prior to the use of antibiotics, isolating bacterial strains in vitro and assaying for antibiotic sensitivity. Results The single blood specimen showed a positive rate of 18.7%. Two blood samples were taken at one time. The positive rate of culture was 30.6%. There was significant difference between the two groups (P <0.05). Infected strains of G-bacteria in 19 cases (52.8%), G + bacteria in 16 cases (44.4%), white yeast strains in 1 case (2.8%). Common pathogens are Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa. Staphylococcus aureus in 2004, there is an upward trend in enterococcal infection. In vitro susceptibility testing showed that resistant strains increased, mainly for cephalosporins, quinolone antibiotics. Conclusion Blood samples of more than 2 times can obviously improve the positive rate of blood culture. The main infection of patients with malignant hematological disease and solid tumor chemotherapy is endogenous bacteria, G- bacteria, G + infection and drug-resistant strains have an upward trend, the reason and irrational use of broad-spectrum antibiotics and hospital cross-infection.