成人血流感染的临床特点及病原学分析

发布时间：2018-03-19 14:31

本文选题：血流感染　切入点：败血症　出处：《中华医院感染学杂志》2017年17期 　论文类型：期刊论文

【摘要】：目的分析血流感染的临床特点及病原菌分布、耐药性特点,为临床抗感染治疗提供依据。方法对医院2006-2015年确诊为血流感染的544例病例资料进行回顾性分析.采用法国生物梅里埃公司BacT/Alert 3D全自动血培养仪对血液标本进行培养,采用法国生物梅里埃公司VITEK-2全自动细菌鉴定系统对细菌培养阳性标本进行菌株鉴定,药敏测定采用纸片扩散法或稀释法。结果 544例血流感染患者平均(59.6±19.9)岁,男性患者286例占52.6%;社区获得性血流感染279例占51.3%,院内获得性感染265例占48.7%,总病死率26.5%;继发血流感染最常见的原发感染部位分别为肺部、泌尿系统、肝胆系统;血培养共分离出病原菌544株,其中革兰阴性菌328株占60.3%,革兰阳性菌153株占28.1%,真菌51株占9.4%,其他菌12株占2.2%,最常见的病原菌依次为大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌85株,占全部大肠埃希菌50.9%,产ESBLs肺炎克雷伯菌24株,占40.0%;耐甲氧西林金黄色葡萄球菌检出34株,占61.8%,耐甲氧西林凝固酶阴性葡萄球菌检出37株,占92.5%;大肠埃希菌对哌拉西林/他唑巴坦、阿米卡星以及亚胺培南的敏感率均90.0%;未检出耐万古霉素革兰阳性菌;利福平对葡萄球菌属较敏感,链球菌属对苯唑西林及头孢噻肟100.0%敏感。结论成人血流感染病原菌以肠杆菌科细菌为主,多药耐药菌检出率较高,定期开展医疗机构内的血流感染监测工作,对于指导抗菌药物合理应用及医院感染管理十分重要。
[Abstract]:Objective to analyze the distribution, clinical features and pathogens of bloodstream infections in drug resistance, provide evidences for clinical anti infection treatment. Methods in hospital 2006-2015 years diagnosed 544 cases of bloodstream infection were retrospectively analyzed. The French bioMerieux BacT/Alert 3D automatic blood culture instrument for blood samples were cultured using automatic bacteria the identification system of bioMerieux VITEK-2 on bacterial culture positive specimens were strain identification, drug susceptibility was determined by disk diffusion or dilution method. Results 544 cases of patients with bloodstream infection in average (59.6 + 19.9), 286 cases of male patients accounted for 52.6%; community acquired bloodstream infection in 279 cases accounted for 51.3% of hospital acquired infection in 265 cases accounted for 48.7% of the total mortality was 26.5%; secondary bloodstream infection the most common primary infection sites were lungs, urinary system, hepatobiliary system; blood culture consists of isolated pathogens 544 strains, including 328 strains of gram negative bacteria accounted for 60.3%, 153 strains of gram positive bacteria accounted for 28.1%, 51 strains of fungi accounted for 9.4%, other 12 strains accounted for 2.2%, the most common pathogens were Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus; extendedspectrum beta. Lactamases (ESBLs) and 85 strains of Escherichia coli accounted for 50.9%, Escherichia coli, ESBLs producing Klebsiella pneumoniae 24 strains, accounting for 40%; methicillin resistant Staphylococcus aureus 34 strains, accounting for 61.8%, methicillin resistant coagulase negative staphylococci were detected in 37 strains of Escherichia coli, accounting for 92.5%; to piperacillin / tazobactam, imipenem sensitive and Amikacin 90%; no detection of vancomycin resistant gram positive bacteria; rifampicin sensitive to Staphylococcus, Streptococcus sensitive to oxacillin and cefotaxime 100%. Conclusion the pathogens of bloodstream infection in adult Enterobacteriaceae bacteria, and more drug resistance The detection rate of drug bacteria is high. It is very important for the rational application of antibiotics and the management of hospital infection to carry out the monitoring of blood flow infection in medical institutions.

【作者单位】：清华大学附属北京清华长庚医院普通内科;北京大学第一医院临床药理研究所;
【基金】：国家科技支撑计划基金资助项目(2012EP001002)
【分类号】：R446.5;R51

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