【摘要】 目的 比较血液内科普通病房与层流病房血液系统恶性疾病患者的血流感染（BSI）情况，分析其病原菌分布及耐药特征。方法 收集2020年1月～2024年12月我院血液内科普通病房与层流病房的全部血培养阳性报告，进行病原菌鉴定与药物敏感性分析，并采用统计学方法比较两类病房间病原菌分布及耐药性差异。结果 共检出来自148例患者的189株病原菌，在普通病房与层流病房中革兰氏阴性菌（G??菌）占大多数，分别为84株（77.1%）和60株（75.0%），且以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌最多[普通病房为45株（41.3%）、18株（16.5%）、6株（5.5%），层流病房为27株（33.8%）、9株（11.3%）和9株（11.3%）]。其中，大肠埃希菌在两病房均具有有效耐药率数据的抗生素共有28种，大部分抗生素单独耐药率间差异无统计学意义（P>0.05），但全体抗生素配对检验提示层流病房的整体耐药性显著强于普通病房（P<0.001）。该结论同样适用于两病房肺炎克雷伯菌中均具有有效数据的20种药物（P=0.004）。此外，层流病房的患者年龄较普通病房小（P<0.001），且在病种上更集中于急性白血病（P=0.004），同时具有更长的住院时间（P<0.001）。结论 血液内科患者的血流感染以G??菌为主，即使在环境病原菌相对较少的层流病房中，G??菌仍因长期化疗和抗生素应用等因素具有更强的耐药性。在血培养结果回报前，可首选抗G??菌药物经验性治疗，同时临床上应加强病原学监测，及时、合理应用抗生素，以改善预后并减少细菌耐药的发生。更多还原

【Abstract】 Objective To compare bloodstream infections(BSI) among hematologic malignancy patients in general wards versus laminar flow wards within our hematology department, and to analyze pathogen distribution and antimicrobial resistance characteristics. Methods All positive blood culture reports from the general and laminar flow wards of our hospital′s hematology department between Jan 2020 and Dec 2024 were collected. Pathogenic bacteria were identified and subjected to drug susceptibility testing. Statistical methods were used to compare pathogen distribution and antimicrobial resistance differences between the two ward types. Results A total of 189 pathogens were isolated from 148 patients. Gram-negative bacteria(G?? bacteria) constituted the majority in both general and laminar flow wards, accounting for 84 strains(77.1 %) and 60 strains(75.0 %), respectively. with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa being the most prevalent [45 strains(41.3 %), 18 strains(16.5 %), and 6 strains(5.5 %) in the general ward; 27 strains(33.8 %), 9 strains(11.3 %), and 9 strains(11.3 %) in the laminar flow ward]. Among these, 28 antibiotics demonstrated effective resistance rates against Escherichia coli in both wards. While individual antibiotic resistance rates showed no statistically significant differences(P>0.05), pairwise comparisons across all antibiotics indicated significantly higher overall resistance in the laminar flow ward compared to the general ward(P<0.001). This conclusion also applied to the 20 antibiotics with effective data for Klebsiella pneumoniae in both wards(P=0.004). Additionally, patients in the laminar flow ward were younger than those in the conventional ward(P<0.001), had a higher concentration of acute leukemia cases(P=0.004), and exhibited longer hospital stays(P<0.001). Conclusion Bloodstream infections in hematology patients are predominantly caused by Gram-negative bacteria. Even in laminar flow wards with relatively fewer environmental pathogens, Gram-negative bacteria exhibit stronger resistance due to prolonged chemotherapy and antibiotic use. Empirical therapy with anti-Gram-negative agents should be prioritized before blood culture results are available. Concurrently, enhanced pathogen monitoring and timely, rational antibiotic use are essential to improve outcomes and reduce bacterial resistance development.更多还原