Objective: To investigate the distribution of pathogens and the antibiotic resistance profile of bloodstream infections in adult patients with hematological diseases in the period 2014-2018 to provide evidence for the rational use of antibiotics. Methods: We retrospectively analyzed the bloodstream infections in patients with hematological diseases from January 2014 to December 2018 at the institute of Hematology & Blood Diseases Hospital; this included an assessment of the clinical characteristics, distribution of pathogens, and antibiotic resistance data. Results: There were 1935 episodes of BSIs in the 1478 patients who were studied; among these, 1700 episodes occurred in the neutropenic phase. The 7-day and 30-day all-cause mortality rates were 5.5% and 8.2%, respectively. Bloodstream infection was usually accompanied by respiratory tract, perianal zone mucositis, and digestive tract symptoms; the respective proportions were 12.4%, 12.3%, and 9.1%, respectively. Total 2025 strains were isolated; 1551 (76.6%) of the pathogens were gram-negative bacteria, mainly Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa; 423 (20.9%) were gram-positive bacteria, mainly Staphylococcus spp. and Streptococcus spp. Viridans; 51 (2.5%) were fungi, mainly Candida tropicalis. The resistance rates of Enterobateriaceae to piperacillin/tazobactam, carbapenems, amikacin were <10%. The resistance rates of K. pneumoniae to cefepime, piperacillin/tazobactam and meropenem increased annually. The resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam, quinolones, Aminoglycosides were <5% even when compared to carbapenems. Eleven stains of methicillin-resistant S. aureus and 1 stain of vancomycin-resistant Enterococcus faecium were detected. Conclusion: The pathogens of bloodstream infection in adult patients with hematological diseases are widely distributed. The resistance rates of different strains vary; the rates in some species had a tendency to increase. Antibiotics should be selected rationally as per the distribution of pathogens and resistance to antibiotics in different patient groups.
目的： 探讨2014-2018年成人血液病患者发生血流感染的病原菌分布和耐药情况，为该类患者合理使用抗菌药物提供数据参考。 方法： 回顾性分析2014年1月至2018年12月中国医学科学院血液病医院收治的血液病合并血流感染患者的临床资料、病原菌种类分布和药物敏感性数据。 结果： 5年内共1 478例血液病患者发生1 935次血流感染，1 700例次（87.9%）发生在中性粒细胞缺乏期，14 d与30 d全因死亡率分别为5.5%和8.2%。52.7%的血流感染存在伴随症状，主要为呼吸道症状、肛周黏膜损伤及消化道症状，比例分别为12.4%、12.3%和9.1%。共分离出2 025株病原菌，革兰阴性菌1 551株（76.6%），主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌；革兰阳性球菌423株（20.9%），主要为葡萄球菌属与草绿色链球菌；真菌51株（2.5%），以热带念珠菌为主。肠杆菌科细菌对哌拉西林/他唑巴坦、碳青霉烯类、阿米卡星耐药率<10%。其中肺炎克雷伯菌对头孢吡肟、哌拉西林/他唑巴坦、美罗培南耐药率呈逐年上升趋势。铜绿假单胞菌对哌拉西林/他唑巴坦、喹诺酮类、氨基糖苷类抗菌药物耐药率<5%，低于碳青霉烯类。共检出耐甲氧西林金黄色葡萄球菌11株，耐万古霉素肠球菌1株。 结论： 成人血液病患者血流感染病原菌分布广泛，不同菌种耐药率差异较大，且部分菌种耐药呈上升趋势，应根据不同人群血流感染病原菌分布及耐药情况合理使用抗菌药物。.
Keywords: Bloodstream infection; Hematological disease; Pathogen; Resistance.