Objective: To investigate the pathogen spectrum distribution and drug resistance of febrile neutropenic patients with hematological diseases in Shanghai. Methods: A retrospective study was conducted on the clinical isolates from the febrile neutropenic patients hospitalized in the departments of hematology in 12 general hospitals in Shanghai from January 2012 to December 2014. The drug susceptibility test was carried out by Kirby-Bauer method. WHONET 5.6 software was used to analyze pathogenic bacteria and drug susceptibility data. Results: A total of 1 260 clinical isolates were collected from the febrile neutropenic patients. Gram-positive bacteria accounted for 33.3% and Gram-negative bacteria accounted for 66.7%. Klebsiella pneumoniae (12.5%) , Stenotrophomonas maltophilia (9.5%) , Escherichia coli (9.1%) , Pseudomonas aeruginosa (8.7%) , Acinetobacter baumannii (6.6%) , Staphylococcus aureus (5.6%) and Enterococcus faecium (5.0%) were ranked in the first 7 of all pathogens. In the respiratory tract secretions specimens, non-fermented strains accounted for 56.2%. Stenotrophomonas maltophilia accounted for 15.2%. Enterobacteriaceae and coagulase-negative Staphylococci accounted for 42.3% (104/246) and 32.6% (85/246) respectively in blood samples. Enterobacteriaceae and Enterococcus bacteria accounted for 39.4% (76/193) and 28.5% (55/193) respectively in pus specimens. The detection rates of methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative Staphylococci (MRCNS) were 54.3% and 82.5%, respectively. Staphylococcus bacterial strain was not found to be resistant to linezolid, vancomycin and teicoplanin. The detection rate of Enterococcus vancomycin-resistant strains was 8.9%. Enterococcus was not detected resistance to oxazolidinone strains. Enterobacteriaceae bacteria were highly sensitive to carbapenems. The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem was 34.1% and 15.8%, respectively. Stenotrophomonas maltophilia was more sensitive to minocycline hydrochloride, levofloxacin and sulfamethoxazole. The resistance rate of Acinetobacter baumannii only to cefoperazone-sulbactam was less than 10.0%. The antibiotic resistance rate of Klebsiella pneumoniae, Stenotrophomonas maltophilia, Pseudomonas aeruginosa and Acinetobacter baumanii to most of common antibiotics was lower than that of the CHINET surveillance. Conclusions: The pathogenic strain distribution in common infection sites of febrile neutropenic patients was characterized. Bacterial resistance surveillance was better than the CHINET nationwide large sample surveillance in China.
目的： 了解上海地区中性粒细胞缺乏（粒缺）伴发热血液病患者致病细菌的分布及耐药情况。 方法： 回顾性分析2012年1月至2014年12月上海市12家医院血液科粒缺伴发热住院患者的临床分离菌株，用纸片扩散法进行药敏试验，WHONET 5.6软件分析病原菌分布及药敏数据。 结果： 从上海地区粒缺伴发热患者中共分离出1 260株细菌，其中革兰阳性菌420株（33.3%），革兰阴性菌840株（66.7%）。排在前七位的分别是肺炎克雷伯菌158株（12.5%）、嗜麦芽窄食单胞菌120株（9.5%）、大肠埃希菌115株（9.1%）、铜绿假单胞菌109株（8.7%）、鲍曼不动杆菌83株（6.6%）、金黄色葡萄球菌70株（5.6%）和屎肠球菌63株（5.0%）。呼吸道分泌物标本中，非发酵菌占56.2%（350/623）。其中嗜麦芽窄食单胞菌占15.3%（95/623）。血液标本中，肠杆菌科细菌占42.3%（104/246），凝固酶阴性葡萄球菌占34.6%（85/246）。脓液标本中肠杆菌科细菌占39.4%（76/193），肠球菌属细菌占28.5%（55/193）。耐甲氧西林金黄色葡萄球菌葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为54.3%和82.5%，未发现耐利奈唑胺、万古霉素、替考拉宁葡萄球菌属菌株，耐万古霉素屎肠球菌的检出率为8.9%，肠球菌属未检出耐利奈唑胺的菌株。肠杆菌科细菌对碳青霉烯类药物高度敏感。铜绿假单胞菌对亚胺培南和美罗培南的耐药率已分别达34.1%和15.8%。嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星、复方磺胺甲恶唑等药物敏感。鲍曼不动杆菌仅对头孢哌酮/舒巴坦的耐药率低于10.0%。肺炎克雷伯菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、鲍曼不动杆菌等革兰阴性菌对大多常用抗菌药物的耐药率低于CHINET监测的数据。 结论： 粒缺伴感染患者常见感染部位致病菌株分布有其特点，细菌耐药率整体低于CHINET全国医院大样本监测。.
Keywords: Drug resistance, bacterial; Fever; Neutropenia.