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目的调查肿瘤患者医院感染病原菌的分布及耐药趋势,为指导临床用药及控制医院感染提供依据。方法对2007年1月～2008年12月住院病人医院感染病原菌进行统计分析。结果共检出病原菌1482株,其中G-菌占59.99%,其次为真菌、革兰阳性菌,分别为22.87%,17.14%。G-菌以大肠埃希菌和肺炎克雷伯菌为主,产超广谱β-内酰胺酶(ESBLs)率分别为57.60%,20.60%,其中大肠埃希菌耐药较严重,仅对亚胺培南、厄它培南和哌拉西林/他唑巴坦、头孢替坦等抗菌药物敏感;G+菌以葡萄球菌属为主,其中耐甲氧西林株金黄色葡萄球菌和凝固酶阴性葡萄球菌分别占25.29%,89.66%,凝固酶阴性葡萄球菌的耐药性较严重,仅对万古霉素、利奈唑烷、喹努普汀/达福普汀敏感,对其他所测抗菌药物的耐药性均高于金黄色葡萄球菌;真菌以白色假丝酵母菌最多,占到致病菌的第2位。结论肿瘤患者医院感染病原菌的耐药问题日趋严重,重视和加强耐药菌医院感染管理,对指导临床合理应用抗菌药物,积极有效地控制医院感染具有重要意义。
Objective To investigate the distribution and drug resistance of nosocomial infections in cancer patients, and provide evidence for clinical drug use and control of nosocomial infection. Methods The pathogens of nosocomial infections in hospitalized patients from January 2007 to December 2008 were statistically analyzed. Results A total of 1482 strains of pathogenic bacteria were detected, of which G-bacteria accounted for 59.99%, followed by fungi, Gram-positive bacteria, which were 22.87% and 17.14%, respectively. G-bacteria were mainly Escherichia coli and Klebsiella pneumoniae, and the rates of ESBLs production were 57.60% and 20.60%, respectively. The E. coli resistance was more serious than G-bacteria. Imipenem, ertapenem and piperacillin/tazobactam, cefotetan and other antimicrobial drugs sensitive; G+ bacteria are mainly Staphylococcus, methicillin-resistant Staphylococcus aureus and coagulase negative Staphylococci accounted for 25.29% and 89.66% respectively. Coagulase-negative staphylococci were more resistant to vancomycin, linezolid, quinupeptin/dalfopristin, and other antibiotics tested. The drug resistance was higher than that of Staphylococcus aureus; the fungus was Candida albicans, which accounted for the second place of pathogenic bacteria. Conclusion The drug resistance of nosocomial pathogens in cancer patients is becoming more and more serious. It is important to pay attention to and strengthen the management of drug-resistant nosocomial infections, to guide the rational use of antibiotics in clinical practice, and to actively and effectively control nosocomial infections.