热带地区血液病患者肺部感染病原菌分析

Analysis of pathogenic characteristics of lung infection in patients with hemopathy in tropics

  • 摘要: 目的 分析我院血液科近年来住院恶性血液病患者肺部感染致病菌分布的特点,为热带地区血液科预防和控制感染提供参考依据。 方法 回顾性分析2014年5月- 2017年11月我院血液科587例疑似肺部感染住院患者的痰培养病原菌特征。 结果 剔除同一患者同期分离的重复菌株,从血液科病区肺部感染的108例病人的158个痰标本中分离培养出病原菌190株,其中真菌101株(占53.2%),革兰阴性菌65株(占34.2%),革兰阳性菌24株(占12.6%)。101株真菌中念珠菌98株,包括白色念珠菌46株、热带念珠菌10株、光滑念珠菌2株、克柔念珠菌1株、其他念珠菌39株,霉菌3株;有44株真菌(其中念珠菌43株,霉菌1株)感染患者合并细菌感染,合并的革兰阴性菌有肠杆菌属11株、嗜麦芽窄食单胞菌7株、皮氏罗尔斯顿菌5株、肺炎克雷伯菌4株、铜绿假单胞菌3株、大肠埃希菌2株、鲍曼不动杆菌2株、溶血不动杆菌1株、其他假单胞菌1株、其他克雷伯菌1株,合并的革兰阳性菌有肠球菌属9株、革兰阳性杆菌2株、金黄色葡萄球菌2株。 结论 热带地区气候条件对肺部感染病原菌的分布有一定影响,同时念珠菌成为血液科患者肺部感染的主要致病菌,念珠菌感染易诱发其他致病菌感染,增加多重耐药菌发生率。

     

    Abstract: Objective To analyze the characteristics of lung infection in patients in department of hematology, provide evidences for clinical prevention and control of infection, so as to reduce the incidence of nosocomial infection in tropical area. Methods A retrospective study was conducted on clinical data about pathogens from sputum culture of 587 inpatients with suspected lung infection admitted to department of hematology in our hospital from May 2014 to November 2017. Results Simultaneous repeated detection data were eliminated. Totally 190 strains of pathogenic bacteria were isolated from 158 sputum specimens in 108 patients with lung infection in department of hematology, including 101 strains (53.2%) of fungi, 65 strains (34.2%) of Gram-negative bacteria and 24 strains (12.6%) of Gram-positive bacteria. Among 101 fungi, there were 98 strains of Candida species (including 46 strains of Candida albicans, 10 strains of Candida tropicalis, 2 strains of Candida albicans, 1 strain of Candida tropicalis, 39 strains of other Candida species), and 3 strains of mould; there were 44 strains of fungi (including 43 strains of Candida and 1 strain of mould) combined with bacterial infection, including 11 strains of Enterobacter, 7 strains of Stenotrophomonas maltophilia, 5 strains of Ralstonia pwkettii, 4 strains of Klebsiella pneumoniae, 3 strains of Pseudomonas aeruginosa, 2 strains of Escherichia coli, 2 strains of Acinetobacter baumannii, 1 strain of Acinetobacter haemolyticus, 1 strain of other Pseudomonas and 1 strain of other Klebsiella, 9 strains of Enterococcus, 2 strains of Gram-positive bacilli and 2 strains of Staphylococcus aureus. Conclusion The climatic condition of tropical area influences the distribution of pathogenic bacteria in lung infection to a certain extent, and we find that Candida albicans is the main pathogen of pulmonary infection in patients of department of hematology. Candida infection may induce other pathogenic bacteria infections, increase the incidence of multidrug-resistant bacteria and threaten the health of patients.

     

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