中文摘要：

目的 探讨近3年北京协和医院血液科患者细菌的流行病学及临床特点.方法 回顾性分析2010至2012年北京协和医院血液科病房所有送检的标本中具有阳性细菌培养结果的患者的资料,了解感染的病原菌分布、部位、疾病状态、治疗反应及转归.结果 共检出阳性致病细菌388例次,占所有送检标本的5.8％.其中社区感染占8.4％,以革兰阴性菌为主（75％）,无耐药菌出现.院内感染占91.6％,最常见的感染部位为呼吸道（49.4％）、血流（32.6％）、皮肤软组织（10.4％）及泌尿系（3.7％）,病原菌分布以革兰阴性菌为主（66.9％）,最多见的革兰阴性菌为大肠埃希菌（13.8％）、铜绿假单胞菌（12.1％）及肺炎克雷伯菌（12.1％）,最多见的革兰阳性菌为金黄色葡萄球菌（10.4％）、屎肠球菌（7.0％）及表皮葡萄球菌（5.1％）.呼吸道、血流感染菌以革兰阴性菌为主,皮肤创面及肛周软组织感染则以革兰阳性菌感染为主.在革兰阳性菌和革兰阴性菌中,均出现了较高比例的耐药菌.多数患者（68.1％）处于粒细胞缺乏及免疫抑制状态.22例（71.9％）患者经治疗后感染得到有效控制.感染相关死亡者42例（13.6％）.共检出定植菌61例次,以嗜麦芽窄食单胞菌及鲍曼不动杆菌等非发酵菌多见.结论 血液病患者院内感染以革兰阴性菌为主,肺部感染及血流感染为最常见的感染部位,不同感染部位的病原菌种类分布不同,目前抗感染治疗后多数患者可得到有效控制,但仍有较高的感染相关死亡率,非发酵菌需鉴别定植菌及致病菌.

英文摘要：

Objective To investigate the incidence,pathogens,and clinical features of infection in consecutive cases from 2010 to 2012 in Peking Union Medical College Hospital.Method The incidence,pathogen,treatment,and outcomes of patients with hematological diseases who had positive findings of bacterium in their samples from 2010 to 2012 were retrospectively analyzed.Results There were 449 positive samples （5.8％） from 4 890 patients during this period,among which 388 were proved to be with pathogenic bacteria.Samples separated from patients with community-aquired infections accounted for 8.4％ of all positive samples.Most community-aquired infections were caused by Gram-negative bacteria （75％）,although no multidrug-resistant bacteria was observed.Samples separated from patients with nosocomial infections accounted for 91.6％ of all positive samples.Respiratory tract （49.4％） and peripheral blood （32.6％） were the most common samples with positive results.Skin soft tissues （10.4％）,and urine （3.7％） were less common samples.Most of the pathogenic bacteria of the nosocomial infections were Gram-negative （66.9％）.The most common Gram-negative bacteria included Escherichia coli （13.8％）,Pseudomonas aeruginosa （12.1％）,and Klebsiella pneumonia （12.1％）,while Staphylococcus aureus （10.4％）,Enterococcus faecium （7.0％）,and Staphylococcus epidermidis （5.1％） were the most common Gram-positive bacteria.Gram-negative bacteria consisted of most of sputum samples and peripheral blood samples.Samples from the surface of skin wound and anal swab were composed largely by Gram-positive bacteria （63.8％）.The detection rates of extended-spectrum beta-lactamase-producing Klebsiella pneumonia/Klebsiella oxytoca,Escherichia coli,and Proteus mirabilis were 24.0％,87.9％ and 38.4％,respectively.The resistance to Acinetobacter baumannii was serious.Multidrug-resistant,extensive drug resistant and pan drug resistant A.baumannii acountted for 74％ of all A.Baumannii infe