静脉置管模式与HM 患者CRBSI 的病原菌 分布及耐药性评估的相关性研究

Catheter related bloodstream infections in patients with hematologic malignancies and drug resistance

摘要:

目的 探讨静脉置管模式与恶性血液病（HM）患者导管相关性血流感染（CRBSI）及耐药性评估 的相关性研究。方法 回顾性分析1 335 例在四家三级甲等医院血液肿瘤科住院的HM 患者行静脉置管后发生 CRBSI 的病例资料。结果 股静脉置管模式的CRBSI 感染率与锁骨下静脉、颈内静脉置管模式的CRBSI 感 染率比较差异有统计学意义（P <0.05）。CRBSI 发生率高低与HM 患者年龄、静脉穿刺次数、导管留置时间、 规范换药与否、白细胞水平、是否合并糖尿病和激素及免疫抑制剂的使用与否相关（P <0.05）。头孢哌酮/ 舒 巴坦、阿米卡星及亚胺培南西司他丁对革兰阴性菌耐药率<20.00% ；鲍曼不动杆菌耐药率>50.00% ；铜绿假单 胞菌、肺炎克雷伯菌及大肠埃希菌耐药率均<50.00%。万古霉素、利奈唑胺及替加环素对3 种革兰阳性菌不耐药； 对利福平的耐药率<20.00% ；对青霉素、苯唑西林、头孢哌酮/ 舒巴坦的抗菌药物敏感试验耐药率>50.00%。结 论 静脉置管模式与CRBSI 有关，CRBSI 病原菌以革兰阴性菌分布最多，对常用抗菌药物的耐药率较高。

Abstract:

Objective To investigate catheter-related bloodstream infections (CRBSI) in patients with hematologic malignancies (HM) , and pathogenic distribution as well as drug susceptibility. Methods A totally of 1,335 cases which were admitted into four hospitals were involved in this study. Species of pathogens as well as clinical information were recorded. Results Femoral vein catheter exerted the lowest incidence of CRBSI compared with internal jugular vein catheter and subclavian vein (P < 0.05). Incidence of CRBSI was closely correlated with age, number of venipuncture, duration of catheter, standard treatment, WBC levels, diabetes mellitus and the usage of the hormone and immune inhibitor (P < 0.05). Incidence of drug resistance of gram-negative bacteria against Cefoperazone/Sulbactam, Amikacin and Imipenem was generally less than 20.00%. Incidence of drug resistance of Acinetobacter Baumannii was generally over 50.00%, while that of pseudomonas aeruginosa, klebsiella pneumoniae and e. coli was less than 50.00%. No drug resistance of gram positive bacteria against Vancomycin, Rina Thiazole Amine and Tigecycline was identified. Incidence of drug resistance of pathogens against Rifampicin was less than 20.00%, while that against Penicillin, Benzene Azole Westwood, and Cefoperazone/Sulbactam was more than 50.00%. Conclusion Gram-negative bacteria is most common pathogen with prevailing drug resistance to various antibiotics in HM patients with venous catheters. Health care providers should standardize operations and choose appropriate antibiotics according to the pathogenic epidemiology.