张盼盼,金皎,曾妮,杨红兰,黄璟
ZHANG Panpan,JIN Jiao,ZENG Ni,YANG Honglan,HUANG Jing

• 1:贵州医科大学附院儿科血液专科
• 2:贵州医科大学
• 3:贵州医科大学附院医院感染科

摘要(Abstract)：

目的:分析血液病(HD)住院患儿医院感染(NI)的临床特点、病原学特征及药敏结果,为防控NI提供科学依据。方法:收集2014-2018年发生NI的217例次HD患儿的临床资料、送检的临床标本培养分离病原菌及药敏实验结果,分析各年度HD患儿的NI率、原发感染部位、检出的主要病原体及药敏结果。结果:HD住院患儿NI发生率3. 57%,2018年最低(3. 03%),2017年最高(4. 34%),不同年份检出率差异有统计学意义(P <0. 001); NI住院HD患儿原发感染部位以下呼吸道为主(占27. 19%),其次是血液系统(占19. 82%);发生NI的HD住院患儿标本中致病菌检出率44. 72%,革兰阴性菌居首位,以大肠埃希菌和肺炎克雷伯杆菌为主,药敏结果显示均对碳青霉烯类抗生素较敏感,对头孢菌素类抗生素、氨曲南大部分耐药。结论:HD患儿NI发生率较高,感染部位以下呼吸道为主,革兰阴性菌是NI的主要菌种。
Objective: To analyze the clinical features,etiological characteristics and drug sensitivity of hospital infection in children with hematological diseases( HD) to provide scientific basis for prevention and control of nosocomial infection( NI). Methods: The clinical data of 217 HD children with NI in 2014-2018 were collected. The clinical samples were cultured to isolate pathogenic bacteria and drug sensitivity test results,and the NI incidence,primary infection location,main pathogenic bacteria detected and drug sensitivity results were analyzed. Results: The incidence of NI was 3. 57%,the lowest in 2018( 3. 03%) and the highest in 2017( 3. 34%). The difference of NI detection rates in different years was statistically significant in( P < 0. 001). The primary infection was mainly in the lower respiratory tract( 27. 19%),followed by the blood system( 19. 82%),and the detection rate of pathogenic bacteria was 44. 72% in the samples of HD inpatients with NI, which was mainly Escherichia coli and Klebsiella pneumoniae. The ressuts of drug sensitivity showed that they were sensitive to carbapenem antibiotics and resistant to most of cephalosporins and aztreonam. Conclusion:The incidence of NI in children with HD is high,mainly in the respiratory tract below the infection sites,gram-negative bacteria is the main strain of infection.

关键词(KeyWords)： 血液病;医院感染;患儿;病原学;药敏结果;耐药
hematological diseases(HD);nosocomial infection(NI);children;etiology;drug sensitivity results;drug resistance

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技计划项目[黔科合平台人才(2019)5406];; 贵阳市科技计划项目[筑科合同(2017)5-20];; 贵州省卫健委科技基金项目(gzwjkj2019-1-002)

作者(Author): 张盼盼,金皎,曾妮,杨红兰,黄璟
ZHANG Panpan,JIN Jiao,ZENG Ni,YANG Honglan,HUANG Jing

DOI: 10.19367/j.cnki.1000-2707.2020.03.015

参考文献(References)：

• [1]胡亚美，江载芳．诸福棠实用儿科学[M]. 8版．北京:人民卫生出版社，2015.
• [2]李春富，孙树梅．儿童血液病多重耐药菌感染的治疗对策[J]．中华实用儿科临床杂志，2015,30(15):1124-1127.
• [3]张家源，陈玉梅，邹尧，等．重症血液病患儿血流感染的临床分析[J]．中华医院感染学杂志，2014(20):5136-5138.
• [4]SARASHINA T,YOSHIDA M,IGUCHI A,et al. Risk factor analysis of bloodstream infection in pediatric patients after hematopoietic stem cell transplantation[J]. Journal of Pediatric Hematology/Oncology,2013,35(1):76-80.
• [5]中华人民共和国卫生部．医院感染诊断标准(试行)[J]．中华医学杂志，2001,81(5):314-320.
• [6]张雅薇，王辉．2016年CLSI M100S(第26版)主要更新内容解读[J]．中华检验医学杂志，2016,39(3):165-169.
• [7]肖秀红，徐凤琴，卢妤，等．儿科血液病患儿医院血流感染分析[J]．中外医学研究，2016,14(25):125-127.
• [8]王凡，赵春亭，韩志海，等．血液病患者社区感染与医院感染临床特征研究[J]．中国临床医生杂志，2016,44(8):25-28.
• [9]张驰，石雨薇，任光旭．血液病院内感染临床特点及防治对策[J]．中国老年学杂志，2017(7):1729-1730.
• [10]牛俊杰，赵丙瑞，崔晓萍，等．恶性血液病化疗后院内感染危险因素研究[J]．肿瘤研究与临床，2015,27(5):345-347.
• [11]高芳，吴艳艳，熊莉娟，等．血液系统疾病儿童患者医院感染发生现状调查[J]．中国消毒学杂志，2014,31(9):992-994.
• [12]TROVA G,PIGNATARI CAMPOS A C,et al. Pharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tract[J]. Brazilian Journal of Infectious Diseases,2014,18(5):512-517.
• [13]GOTO M,Al-HASAN M N. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe[J]. Clinical Microbiology&Infection the Official Publication of the European Society of Clinical Microbiology&Infectious Diseases,2013,19(6):501-509.
• [14]ALI N,ADIL S N,SHAIKH M U. Bloodstream and central line isolates from hematopoietic stem cell transplant recipients:data from a developing country[J]. Transplant Infectious Disease an Official Journal of the Transplantation Society,2014,16(1):98-105.
• [15]CANIZA M A,ODIO C,MUKKADAU S,et al. Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries[J]. Expert Review of Hematology,2015,8(5):627.
• [16]ALAM M T,RD P R,CRISPELL E K,et al. Dissecting vancomycin-intermediate resistance in staphylococcus aureus using genome-wide association[J]. Genome Biology&Evolution,2014,6(5):1174-1185.
• [17]INABA H,GAUR A H,CAO X,et al. Feasibility,efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia[J].Cancer,2014,120(13):1985-1992.
• [18]刘晨曦，魏辉，周春林，等．替加环素治疗急性白血病化疗后粒细胞缺乏患者血流感染1例[J]．实用医学杂志，2016,32(8):1378.
• [19]VAZQUEZ L. Antifungal prophylaxis in immunocompromised patients[J]. Mediterranean Journal of Hematology&Infectious Diseases,2016,8(1):40.
• [20]INAZAWA N,HORI T,HATAKEYAMA N,et al.Large-scale multiplex polymerase chain reaction assay for diagnosis of viral reactivations after allogeneic hematopoietic stem cell transplantation[J]. Journal of Medical Virology,2015,87(8):1427-1435.
• [21]LEVINSEN M,SHABANEH D,BOHNSTEDT C,et al.Pneumocystis jiroveci pneumonia prophylaxis during maintenance therapy influences methotrexate/6-mercaptopurine dosing but not event-free surv1ival for childhood acute lymphoblastic leukemia[J]. European Journal of Haematology,2015,88(1):78-86.

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