重症监护病房PICC相关血流感染的病原菌分布及耐药性分析

发布时间：2018-06-05 15:57

本文选题：重症监护病房 + PICC　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:掌握我院重症监护病房2011年1月-2014年12月经外周静脉置入中心静脉导管(PICC)的相关血流感染病原菌的分布特点及耐药情况,帮助临床医师确诊导管相关血流感染,为临床预防、诊断和治疗提供科学依据。同时,也为控制院内感染提供参考依据,从而使PICC护理程序进一步规范化、程序化。方法:1研究对象研究2011年1月-2014年12月我院重症监护病房ICU患者,出现发热、寒战和/或低血压,而无其他明显的感染来源,或穿刺点局部出现炎性表现甚至化脓等症状。疑似经外周静脉置入中心静脉导管感染病例423例,进行血培养和导管尖端培养。2导管管尖培养接种方法(半定量培养):取导管尖端5cm,接种在哥伦比亚血平板、麦康凯平板及营养肉汤内(增菌)。在平板表面,导管尖端来回滚动1次,经培养24小时后,培养出细菌的菌落数≥15CFU/平板,即为阳性。随后进行分纯、鉴定及药敏。3血培养分别从中心静脉导管、外周静脉同时抽血送血培养,血培养瓶置于梅里埃全自动血培养仪Bac T/ALERT 3D中进行培养。血培养结果一致(菌种和药敏结果);二者细菌浓度比例超过5:1;血培养报阳的时间中心静脉导管所取血样比外周静脉血提前2个小时以上。一旦血培养仪报告阳性,转种哥伦比亚血平板,麦康凯平板,培养24小时后,进行鉴定及药敏。4菌株鉴定及药敏测定按照美国临床实验室标准化协会标准,使用采用VITEK2 compact和ATB Expression细菌鉴定药敏分析仪对细菌进行鉴定及药敏分析。菌悬液的配置:使用新鲜的纯培养物进行检测(菌龄:18-24小时),悬浮液:0.85%Na CL或去离子水调制相应的鉴定菌悬液浓度,并使用DENSITMAT比浊仪校正浓度,使其菌悬液的浓度在0.5-0.63麦氏比浊。再上机进行鉴定和药敏。结果:1病原菌种类及构成疑似PICC感染患者423例中,确诊导管相关性血流感染34例,阳性率为8.04%,共分离出38株病原菌。其中革兰阳性菌23株,占60.52%,分别为金黄色葡萄球菌9株、溶血葡萄球菌6株、粪肠球菌4株、表皮葡萄球菌2株、屎肠球菌1株、人葡萄球菌1株。其中4株金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌(MRSA),4株溶血葡萄球菌为耐甲氧西林凝固酶阴性葡萄球菌(MRSCON)。革兰阴性菌11株,占28.95%,分别是肺炎克雷伯菌3株、大肠埃希菌3株、粘质沙雷菌3株、琼氏不动杆菌1株、铜绿假单胞菌1株。其中1株大肠埃希菌是产超广谱β-内酰胺酶(ESBL)的菌株,2株肺炎克雷伯菌是产超广谱β-内酰胺酶(ESBL)的菌株。真菌4株,占10.53%,分别是光滑假丝酵母菌2株、近平滑假丝酵母菌1株、白假丝酵母菌1株。2分离菌株时间分布2011年至2014年培养分离到导管相关血流感染病原菌38株,分别为2011年19株分离率为13.1%、2012年3株分离率为4.0%、2013年8株分离率为8.3%和2014年8株分离率为8.3%。其分离率成逐年递减的趋势。3菌株药敏试验结果23株革兰阳性菌对万古霉素、替考拉宁、呋喃妥因、喹奴普汀/达福普汀敏感率较高,对青霉素,红霉素、克林霉素,复方新诺明、苯唑西林、诺氟沙星耐药性较高。11株革兰阴性菌,对哌拉西林/他唑巴坦、氨苄西林/舒巴坦、阿米卡星、碳青霉烯类敏感率较高,对阿莫西林、哌拉西林、氨苄西林、头孢噻吩、头孢西丁耐药性较高。所分离出的假丝酵母菌中,白假丝酵母菌对氟康唑、两性霉素B、5-氟胞嘧啶、伊曲康唑、伏立康唑均较敏感,光滑假丝酵母菌对氟康唑和伊曲康唑敏感性低。结论:1疑似PICC导管感染患者423例中,确诊导管相关性血流感染34例,阳性率为8.04%。在医院开始应用PICC阶段感染率较高,达13.10%。2 PICC导管相关性血流感染病原菌以革兰阳性菌为主,占60.52%;其次为革兰阴性菌,占28.95%,真菌,占10.53%。3葡萄球菌和肠杆菌科细菌是经外周静脉置入中心静脉导管相关血流感染的主要病原菌,病原菌耐药现象较为普遍。4 PICC需要医院具备规范化操作培训模式和完善的管理机制。
[Abstract]:Objective: to understand the distribution characteristics and drug resistance of the pathogenic bacteria in the central venous catheter (PICC) of the peripherally inserted central venous catheter (PICC) in the intensive care unit of our hospital in January 2011 -2014 years -2014 years, to help clinicians to confirm the catheter related blood flow infection, and to provide a scientific basis for clinical prevention, diagnosis and treatment. To provide a reference basis to further standardize and program the PICC nursing procedure. 1 research subjects studied ICU patients in ICU of our hospital in December January 2011, with fever, chills and / or hypotension, without any other obvious source of infection, or local inflammation or even suppurative symptoms in the punctures. 423 cases of peripherally inserted central venous catheter infection were inoculated in blood culture and ductal tip culture of.2 catheter tip culture (semi quantitative culture): Taking the catheter tip 5cm, inoculated in Columbia blood plate, Mai Kang Kai plate and nourishment broth (increasing bacteria). On the flat surface, the catheter tip rolled back and forth 1 times and cultured for 24 hours after culture. The number of bacterial colonies was more than 15CFU/, which was positive. Then, the bacteria were purified, identified and sensitized.3 blood culture from the central venous catheter, peripheral vein blood and blood culture, and the blood culture bottle was cultured in the Bac T/ALERT 3D of the full-automatic blood culture instrument of the maseret. The results of blood culture were consistent (bacteria and drug sensitivity results); the two bacteria were bacteria. The concentration ratio was more than 5:1; the blood samples taken from the central venous catheter in the time central venous catheter for blood culture were more than 2 hours ahead of the peripheral venous blood. Once the blood culture instrument was reported positive, the Columbia blood plate was transferred to the wheat Kang Kai plate, and after 24 hours culture, the identification and identification of the drug sensitive.4 strain and the determination of drug sensitivity were in accordance with the American clinical laboratory standardization association. Standard, using VITEK2 compact and ATB Expression identification drug sensitivity analyzer for identification and drug sensitivity analysis. Configuration of bacterial suspension: use fresh pure culture to test (age: 18-24 hours), suspension: 0.85%Na CL or deionized water modulation phase identification of bacterial suspension concentration, and use DENSITMAT turbidimeter calibration In positive concentration, the concentration of the bacterial suspension was cloudy at 0.5-0.63 Mastle. Then the identification and drug sensitivity were carried out on the machine. Results: among the 1 pathogenic bacteria and 423 cases of suspected PICC infection, 34 cases of catheter related blood flow infection were confirmed, the positive rate was 8.04%, and 38 strains were isolated. Among them, 23 strains of Gram-positive bacteria, accounting for 60.52%, were golden yellow grapes. 9 strains of Staphylococcus, 6 strains of hemolytic Staphylococcus, 4 strains of Enterococcus faecalis, 2 strains of Staphylococcus epidermidis, 1 strains of Enterococcus faecium, 1 strains of Staphylococcus aureus, 4 of Staphylococcus aureus were methicillin resistant Staphylococcus aureus (MRSA), 4 strains of hemolytic Staphylococcus were methicillin resistant coagulase negative staphylococcus (MRSCON). 11 strains of Gram-negative bacteria, accounting for 28.95%, 28.95%. 3 strains of Klebsiella pneumoniae, 3 strains of Escherichia coli, 3 strains of salebella mucilinae, 1 strains of Acinetobacter jonmannii, 1 strains of Pseudomonas aeruginosa, 1 strains of Escherichia coli were strains producing broad-spectrum beta lactamase (ESBL) and 2 strains of Klebsiella pneumoniae were strains of broad-spectrum beta lactamase (ESBL). Fungi 4, respectively, were smooth Pseudomonas. 2 strains of mother bacteria, 1 strains of Candida albicans, and 1 strains of Candida albicans isolated from.2 from 2011 to 2014, 38 isolates were isolated from 19 strains in 2011, 13.1% in 2011, 4% in 2012, 8.3% in 2013 and 8.3%. in 2014 for 8.3% and 8.3%. in 2014. Drug sensitivity test of strain.3, 23 strains of Gram-positive bacteria were sensitive to vancomycin, teicoplanin, furanotin, quetiapine / Dafoe prtin, and penicillin, erythromycin, clindamycin, compound penicillin, oxacillin, norfloxacin,.11 resistant gram-negative bacteria, and piperacillin / tazobactam and ampicin Xilin / sulbactam, Amikacin, carbapenems were sensitive to amoxicillin, piperacillin, ampicillin, cefotathiophene, and cefoxitin. Candida albicans isolated from Candida albicans were sensitive to fluconazole, amphotericin B, 5- fluorosinidine, itraconazole, and voriconazole. Conclusion: 1 of 423 patients with suspected PICC catheter infection, 34 cases of catheter related blood flow infection were diagnosed. The positive rate of the positive rate was that the infection rate of 8.04%. in the PICC stage was higher in the hospital, and the pathogenic bacteria of the 13.10%.2 PICC catheter related bloodstream infection were mainly Gram-positive bacteria, accounting for 60.52%, and the second was gram negative. Bacteria, accounting for 28.95%, fungi, 10.53%.3 Staphylococcus and Enterobacteriaceae are the main pathogens of central venous catheter related blood flow infection through peripherally inserted vein. The drug resistance of pathogenic bacteria is more common.4 PICC needs standardized operation training mode and perfect management mechanism in hospital.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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