儿童急性淋巴细胞白血病化疗后血流感染的病原体分布与耐药变迁分析

Distribution and drug resistance profiles of pathogens causing bloodstream infectionafter chemotherapy in children with acute lymphoblastic leukemia

摘要:

目的 研究儿童急性淋巴细胞白血病化疗后血流感染病原体分布变化及耐药变迁趋势。 方法 收集2015年1月至2020年12月郑州大学第一附属医院收治的急性淋巴细胞白血病化疗后血流感染患儿的临床资料，并按送检时间分为前3年组和后3年组，分析病原体分布及耐药性的差异。 结果 共检出病原体235株，其中革兰阴性菌159株（67.7%），以大肠埃希菌和肺炎克雷伯菌为主；革兰阳性菌61株（26.0%），以表皮葡萄球菌为主；真菌15株（6.4%），以白色念珠菌为主。前3年组和后3年组革兰阴性菌（68.8% vs 66.9%）、革兰阳性菌（29.2% vs 23.7%）比例差异无统计学意义（P>0.05），后3年组缓症链球菌（5.8% vs 0.0%）和真菌（9.4% vs 2.1%）比例较前3年组增高（P<0.05），两组间革兰阴性菌和革兰阳性菌的耐药率差异无统计学意义（P>0.05）。 结论 急性淋巴细胞白血病患儿化疗后血流感染病原体以肠杆菌科细菌为主，而缓症链球菌和真菌检出呈增多趋势，临床需重视。

Abstract:

Objective To study the changes in the distribution and drug resistance profiles of pathogens causing bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia.Methods The medical data were collected from the children with acute lymphoblastic leukemia who were admitted to the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2020 and developed bloodstream infection after chemotherapy.The samples were divided into the first three years group and the next three years group according to the time of testing to investigate the differences in the distribution and drug resistance profiles of pathogens as time.Results A total of 235 strains of pathogens were isolated,among which there were 159 Gram-negative strains(67.7%;mainly Escherichia coli and Klebsiella pneumoniae),61 Gram-positive strains(26.0%;mainly Staphylococcus epidermidis),and 15 strains of fungi(6.4%;mainly Candida albicans).There were no significant differences between the first three years group and the next three years group in the detection rate of Gram-negative bacteria(68.8%vs 66.9%,P>0.05)or Gram-positive bacteria(29.2%vs 23.7%,P>0.05).Compared with the first three years group,the next three years group had significant increases in the detection rate of Streptococcus mitis(5.8%vs 0.0%,P<0.05)and fungi(9.4%vs 2.1%,P<0.05).There was no significant difference in the drug resistance rate of Gram-negative or Gram-positive bacteria between the two groups(P>0.05).Conclusions Enterobacteriaceae bacteria are the main pathogens of bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia,while the detection rates of Streptococcus mitis and fungi tend to increase as time,which needs to be taken seriously in clinical practice.