恶性血液肿瘤患儿化疗后感染产ESBLs细菌耐药性分析

Drug resistance of extended-spectrum-β-lactamases-producing bacteria in children with hematological malignancy after chemotherapy

摘要:

目的：观察恶性血液肿瘤患儿化疗后血液培养产超广谱β-内酰胺酶(ESBLs)病原菌的检出率及其耐药性。方法：回顾性收集2002~2008年因化疗后严重感染的3264例恶性血液肿瘤患儿的临床资料，采取Bact/ALTER 3D 720全自动快速血培养仪对患儿的静脉血样进行培养，VITEK 60细菌检定仪进行菌株鉴定及药敏试验，结果按美国NCCLS标准判读。结果：检出大肠埃希菌58例，肺炎克雷伯杆菌51例，其中产ESBLs菌株分别为38例和19例，产ESBLs病原菌总检出率为52.3%（57/109）。产酶菌株对常用抗生素耐药率明显高于未产酶菌株，两者对亚胺培南、哌拉西林-他唑巴坦及阿米卡星保持高敏感性。结论：恶性血液肿瘤化疗后感染患儿产ESBLs病原菌检出率较高；产ESBLs细菌对常规抗生素耐药性高，病原菌培养及药物敏感性试验能有效指导临床抗菌治疗。

Abstract:

OBJECTIVE: To study the prevalence and drug resistance of extended-spectrum-β-lactamases (ESBLs)-producing bacteria in blood culture isolated from children with hematological malignancy after chemotherapy. METHODS: Blood samples taken from 3264 children with hematological malignancy and severe infection following chemotherapy between 2002 and 2008 were cultured using the Bact/ALTER 3D blood culture system. VITEK 60 automicroscan was used to identify viral species and to conduct drug resistance tests. The results were indentified according to National Committee for Clinical Laboratory Standard guidelines. RESULTS: Fifty-eight strains of Escherichia coli and fifty-one strains of Klebsiella pneumoniae were isolated. Thirty-eight strains of Escherichia coli and nineteen strains of Klebsiella pneumoniae were ESBLs-producing and these ESBLs-producing strains were less susceptible than those that were non-ESBLs-producing to most antibiotics. Both ESBL- and non-ESBL-producing strains were susceptible to imipenem, piperacillin/tazobactam and amikacin. CONCLUSIONS: The prevalence of ESBLs-producing bacteria is high in childrn with hematological malignancy and infection following chemotherapy. ESBLs-producing bacteria are resistant to common antibiotics, suggesting that antibiotic treatment based on the result of antimicrobial susceptibility test is necessary in these children.