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肿瘤患者的耐药菌分布特点
韩涛,吕扬,王东浩
0
天津医科大学肿瘤医院重症监护科,国家肿瘤临床医学研究中心;天津市“肿瘤防治”重点实验室;天津市恶性肿瘤临床医学研究中心天津 300060
摘要:
目的:了解肿瘤患者的细菌分布及耐药特点。方法:对天津医科大学肿瘤医院(TMUCH)2016—2018年检出的菌株进行归类分析,并与2016、2017年中国细菌耐药监测(CHINET)报道的细菌耐药率结果进行对比。结果:TMUCH2016—2018年各菌株构成比变化不大。革兰阳性菌耐药率方面,耐苯唑西林金黄色葡萄球菌呈逐年上升趋势,但总体耐药率不高,且低于CHINET报道;耐苯唑西林凝固酶阴性葡萄球菌呈逐年下降趋势,与CHINET报道无明显差别,且均处于高耐药水平;耐氨苄西林粪肠球菌呈逐年上升趋势,与CHINET报道趋势相反,但总体耐药率较低;耐氨苄西林屎肠球菌三年变化不大,总体耐药率低于CHINET报道,但均处于高耐药水平;主要革兰阳性菌对临床常用高级别抗生素如:万古霉素、利奈唑胺、替加环素,均未见耐药株或仅有极少耐药株。革兰阴性菌耐药率方面,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢吡肟、亚胺培南、替加环素,耐药率均呈较低水平,且基本低于CHINET报道或与其相当。但阴沟肠杆菌、嗜麦芽窄食单胞菌呈现出了较高的耐药率以及逐年增长的趋势,并且高于CHINET报道。结论:肿瘤患者的耐药菌分布与普通感染患者不尽相同,临床中应根据其自身特点合理选择抗生素。
关键词:  耐药率  革兰阳性菌  革兰阴性菌  中国细菌耐药监测  肿瘤
DOI:10.3969/j.issn.1007-6948.2021.02.003
投稿时间:2020-08-09
基金项目:
Distribution Characteristics of Drug-resistant Bacteria in Cancer Patients
HAN Tao,LYU Yang,WANG Dong-hao
Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin' s Clinical Research Center for Cancer, Tianjin 300060, China
Abstract:
Objective To understand the distribution and drug resistance of bacteria in cancer patients. Methods The strains detected in Tianjin Medical University Cancer Hospital (TMUCH) from 2016 to 2018 were classified and analyzed, and the results were compared with the results reported in CHINET2016 and CHINET2017. Results The composition of each strain in TMUCH changed little from 2016 to 2018. As for the drug resistance rate of Gram-positive bacteria, oxacillin-resistant Staphylococcus aureus showed increased year by year, but the overall drug resistance rate was not high and lower than that reported by CHINET; oxacillinresistant coagulase-negative Staphylococcus showed decreased year by year, and there was no significant difference compared with CHINET reports, and they were all at a high drug resistance level. The ampicillin-resistant Enterococcus faecalis were increased on the contrary of CHINET reported, but the overall drug resistance rate is low; ampicillin-resistant Enterococcus faecium has not changed in three years, and the overall drug resistance rate is lower than that reported by CHINET, but all of them are at a high level of drug resistance. The main Gram-positive bacteria have no or very few resistant strains to high-level antibiotics commonly used in clinic, such as vancomycin, linezolid and tegacycline. For Gram-negative bacteria, the drug resistance rates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii to piperacillin/ tazobactam, cefepime, imipenem and tegacycline were lower or equivalent than those reported by CHINET. However, Enterobacter cloacae and Stenotrophomonas maltophilia showed a higher drug resistance rate and an increasing trend year by year, which was higher than that reported by CHINET. Conclusion The distribution of drug-resistant bacteria in cancer patients is different from that in patients with common infection. Antibiotics should be reasonably selected according to their own characteristics.
Key words:  Drug resistant rate  gram positive  gram negative  CHINET  cancer

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