肠球菌血流感染50例临床研究

发布时间：2018-06-08 04:52

本文选题：血流感染 + 肠球菌　；参考：《中国感染与化疗杂志》2016年04期

【摘要】：目的分析肠球菌血流感染的临床特征及病原菌分布,为临床诊疗提供依据。方法回顾性分析2013年1月-2014年12月厦门某三甲医院的50例肠球菌血流感染患者资料。细菌鉴定和药敏试验采用法国生物梅里埃的VITEK2-Compact全自动微生物分析系统。药敏结果统计采用WHONET 5.6软件。结果 50例肠球菌血流感染患者中分离的病原菌包括26株粪肠球菌和24株屎肠球菌;患者基础疾病包括肿瘤17例、2型糖尿病5例、急性胆管炎3例等。易感因素包括导管留置29例、手术19例、低蛋白血症6例、粒细胞减少5例、入住ICU 7例、使用呼吸机5例。23例患者存在原发感染病灶,其中感染肠球菌例数/感染例数比56.5%(13/23):尿路感染6/7、手术部位感染4/4和胆道感染1/4等。粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替加环素全部敏感。粪肠球菌对青霉素和氨苄西林全部敏感,而屎肠球菌对奎奴普丁-达福普汀100%敏感。对高浓度氨基糖苷类敏感的粪肠球菌菌株分别为庆大霉素50.0%(13/26)、链霉素65.4%(17/26);屎肠球菌为庆大霉素25.0%(6/24)和链霉素62.5%(15/24)。46例在血培养结果回报前经验性使用了抗菌药物,41例经验抗菌治疗不合适(占89.1%)。32例患者根据药敏结果针对性的调整用药,17例好转,2例死亡。结论对于肠球菌血流感染,临床经验抗菌治疗常不合适,预后并不理想;粪肠球菌和屎肠球菌对抗菌药物的敏感性存在一定差异,及时根据药敏结果针对性抗菌治疗对感染的控制及患者的预后有着积极的意义。
[Abstract]:Objective to analyze the clinical characteristics and pathogenic bacteria distribution of Enterococcus blood stream infection and to provide evidence for clinical diagnosis and treatment. Methods from January 2013 to December 2014, 50 patients with enterococcal blood flow infection in a hospital in Xiamen were retrospectively analyzed. The bacterial identification and drug sensitivity test were carried out using the VITEK2-Compact automatic microbiological analysis system of French Bio-Merier. WHONET 5.6 software was used to calculate the results of drug sensitivity. Results 26 strains of Enterococcus faecalis and 24 strains of Enterococcus faecium were isolated from 50 patients with blood stream infection of Enterococcus faecalis, and the underlying diseases included 17 cases of type 2 diabetes mellitus and 3 cases of acute cholangitis. The risk factors included catheter indwelling in 29 cases, surgery in 19 cases, hypoproteinemia in 6 cases, granulocytopenia in 5 cases, ICU in 7 cases, ventilator in 5 cases and primary infection in 23 cases. Among them, Enterococcus infection / infection number is 56.5 / 13 / 23: urinary tract infection 6 / 7, surgical site infection 4 / 4, biliary tract infection 1 / 4, etc. Enterococcus faecalis and Enterococcus faecium were all sensitive to vancomycin, linazolamine and tegicycline. Enterococcus faecalis was all sensitive to penicillin and ampicillin, while Enterococcus faecium was 100% sensitive to Quinoptin-Dafopentin. The strains of Enterococcus faecalis sensitive to high concentration aminoglycosides were Gentamycin 50.013 / 26, streptomycin 65.4 / 26; Enterococcus faecium 25.0 / 24) and streptomycin 62.515 / 24 / 46; 41 cases of empirical anti-antibiotics were used before the return of blood culture results. Bacteriological therapy was not suitable (89. 1%). According to the results of drug sensitivity, 17 cases were improved and 2 cases died. Conclusion in the treatment of Enterococcus blood stream infection, the clinical experience is not suitable for antibacterial treatment, and the prognosis is not satisfactory, the sensitivity of Enterococcus faecalis and Enterococcus faecium to antimicrobial agents is different. Timely antimicrobial therapy based on drug sensitivity results has positive significance for infection control and prognosis of patients.
【作者单位】：厦门大学附属第一医院暨福建医科大学教学医院检验科;厦门大学附属第一医院同民分院暨厦门市第五医院;
【基金】：国家自然科学基金(81302529) 福建省自然科学基金(2014D007)
【分类号】：R446.5

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