Objective: To analyze the distribution and drug resistance of pathogens in oral mucositis associated with chemotherapy in hospitalized patients with malignant hematopathy, so as to provide scientific evidences for rational selection of antibiotics and infection prevention and control.
Methods: From July 2020 to June 2022, 167 patients with malignant hematopathy were treated with chemical drugs in the Department of Hematology, Hainan Hospital, and secretions from oral mucosal infected wounds were collected. VITEK2 COMPECT automatic microbial identification system (BioMerieux, France) and bacterial susceptibility card (BioMerieux) were used for bacterial identification and drug susceptibility tests.
Results: A total of 352 strains of pathogens were isolated from 167 patients, among which 220 strains of Gram-positive bacteria, 118 strains of Gram-negative bacteria and 14 strains of fungi, accounted for 62.50%, 33.52% and 3.98%, respectively. The Gram-positive bacteria was mainly Staphylococcus and Streptococcus, while Gram-negative bacteria was mainly Klebsiella and Proteus. The resistance of main Gram-positive bacteria to vancomycin, ciprofloxacin and gentamicin was low, and the resistance to penicillin, cefuroxime, ampicillin, cefotaxime, erythromycin and levofloxacin was high. The main Gram-negative bacteria had low resistance to gentamicin, imipenem and penicillin, but high resistance to levofloxacin, cefotaxime, cefuroxime, ampicillin and vancomycin. The clinical data of oral mucositis patients with oral ulcer (severe) and without oral ulcer (mild) were compared, and it was found that there were statistically significant differences in poor oral hygiene, diabetes, sleep duration less than 8 hours per night between two groups (P<0.05).
Conclusion: Gram-positive bacteria is the main pathogen of oral mucositis in patients with malignant hematopathy after chemotherapy. It is sensitive to glycopeptide antibiotics and aminoglycosides antibiotics. Poor oral hygiene, diabetes and sleep duration less than 8 hours per night are risk factors for oral mucositis with oral ulcer (severe).
题目: 恶性血液病患者化疗相关性口腔黏膜炎病原菌分布及耐药性分析.
目的: 分析恶性血液病住院患者化疗相关性口腔黏膜炎病原菌分布及耐药现状，为临床合理选择抗菌药物及感染防控提供科学依据.
方法: 采集解放军总医院海南医院血液科自2020年7月至2022年6月收治的167例恶性血液病行化学药物治疗后口腔黏膜炎患者的口腔黏膜感染创面的分泌物，采用VITEK2 COMPECT全自动微生物系统及药敏卡片进行细菌鉴定和药敏试验.
结果: 167例患者中共分离病原菌株352株,其中G+菌220株、G-菌118株、真菌14株，占比分别为62.50%、3352%和3.98%。G+菌主要为葡萄球菌属和链球菌属，G-菌主要为克雷伯氏菌属和变形杆菌属。主要G+菌对万古霉素、环丙沙星、庆大霉素的耐药性较低，对青霉素、头孢呋辛、氨苄西林、头孢噻肟、红霉素、左氧氟沙星的耐药性较高。主要G-菌对庆大霉素、亚胺培南、青霉素的耐药性较低，对左氧氟沙星、头孢噻肟、头孢呋辛、氨苄西林、万古霉素的耐药性较高。对比口腔黏膜炎中伴口腔溃疡（重症）与不伴口腔溃疡（轻症）患者的临床资料，两组在口腔卫生情况差、伴有糖尿病、每晚睡眠时长<8 h方面差异均有统计学意义（P<0.05）.
结论: G+菌是血液病患者化疗后口腔黏膜炎主要的病原菌，对糖肽类抗生素及氨基糖苷类抗生素敏感,对喹诺酮类、β-内酰胺类抗生素耐药性高。口腔卫生情况差、伴有糖尿病、每晚睡眠时长<8 h为发生口腔黏膜炎伴口腔溃疡（重症）的危险因素.
Keywords: chemotherapy associated oral mucositis; drug resistance; malignant hematopathy; pathogen.