患者导管相关性血流感染的病原学变化研究

发布时间：2019-06-13 10:10

【摘要】：目的探讨重症监护病房(ICU)及非ICU患者导管相关性血流感染(CRBSI)的发生、病原菌分布及其耐药性,为其预防控制、合理使用抗菌药物提供科学依据。方法对2013年1月-2014年12月医院ICU及非ICU留置中央静脉导管(CVC)的患者进行前瞻性监测,统一CRBSI诊断标准分析其临床特点、病原菌构成和药物敏感试验结果。结果 2013年1月-2014年12月共监测患者4 175例,累计中央静脉置管日共38 984d,发生CRBSI 125例次,CRBSI感染率为3.21‰;共分离出病原菌131株,其中革兰阴性菌74株占56.49%,革兰阳性菌37株占28.24%,真菌20株占15.27%;主要的病原菌中耐甲氧西林凝固酶阴性葡萄球菌、耐碳青霉烯类肺炎克雷伯菌、产ESBLs大肠埃希菌、耐美罗培南铜绿假单胞菌检出率分别为75.0%、23.5%、30.8%、33.3%;凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因的敏感率均为100.0%,铜绿假单胞菌对氨基糖苷类、喹诺酮类耐药率低,均10.0%,热带念珠菌对伊曲康唑和氟康唑耐药率为50.0%和25.0%。结论监测ICU以及非ICU的CRBSI发生以及病原学变化,有助于进一步加强有效的预防控制措施和提供早期的经验性抗菌药物治疗方案。
[Abstract]:Objective to investigate the occurrence, distribution and drug resistance of catheter-associated blood flow infection (CRBSI) in patients with (ICU) and non-ICU in intensive care unit (ICU), and to provide scientific basis for its prevention and control and rational use of antibiotics. Methods from January 2013 to December 2014, patients with ICU and non-ICU indwelling central venous catheter (CVC) were monitored prospectively. The clinical characteristics, pathogen composition and drug sensitivity test results were analyzed by unified CRBSI diagnostic criteria. Results from January 2013 to December 2014, a total of 4175 patients were monitored, with a total of 38984 days of central vein catheterization, 125 cases of CRBSI occurred, and the infection rate of CRBSI was 3.21 per thousand. A total of 131 strains of pathogenic bacteria were isolated, including 74 strains of Gram-negative bacteria (56.49%), 37 strains of Gram-positive bacteria (28.24%) and 20 strains of fungi (15.27%). Among the main pathogens, methicillin-resistant coagulase-negative Staphylococcus, carbapenem-resistant Klebsiella pneumoniae, ESBLs-producing Escherichia coli, meropenem resistant Pseudomonas aeruginosa were 75.0%, 23.5%, 30.8% and 33. 3%, respectively. The sensitivity rates of coagulase negative staphylococci to vancomycin, linazodine, tegacycline and furantoin were 100.0%, Pseudomonas aeruginosa was low to aminoglycosides and quinolones were 10.0%, and the resistance rates of candida tropicalis to itraconazole and fluconazole were 50.0% and 25.0%, respectively. the resistance rates of Pseudomonas aeruginosa to aminoglycosides and quinolones were 10.0% and 25.0%, respectively. Conclusion Monitoring the occurrence and etiological changes of ICU and non-ICU CRBSI is helpful to further strengthen effective preventive and control measures and provide early empirical antibacterial therapy.
【作者单位】：杭州市第一人民医院医院感染管理科;杭州市第一人民医院医院检验科细菌室;杭州市第一人民医院医院血液科;杭州市第一人民医院医院老年内科;杭州市第一人民医院医院胃肠外科;
【基金】：浙江省科技厅重大科技专项计划基金资助项目(2014C03042-2) 杭州市科技发展计划项目医疗卫生及重点专科专病科研攻关专项基金资助项目(20120633B01)
【分类号】：R446.5

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