心脏外科患者感染病原菌的耐药性监测分析

发布时间：2018-01-28 05:30

本文关键词： 心脏外科铜绿假单胞菌耐药性选择应用　出处：《中华医院感染学杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的调查医院心脏外科患者感染病原菌的现状,分析病原菌耐药性及患者抗菌药物的选择应用情况,为临床研究和医师选择抗菌药物提供参考依据。方法选择2015年6月-2016年6月医院心脏外科患者200例,分别对患者的临床资料、细菌耐药性和抗菌药物使用进行回顾性调查,并对药物选择的合理性和相关性进行分析。结果 200例患者术后共发生感染35例,感染率为17.5%;感染患者标本培养出病原菌92株,以革兰阴性菌为主53株,占57.61%,其中肺炎克雷伯菌最多18株,占19.57%;革兰阳性球菌33株,占35.87%,其中金黄色葡萄球菌最多17株,占18.48%;肺炎克雷伯菌、铜绿假单胞菌与大肠埃希菌对亚胺培南有较高的敏感性,耐药率分别为22.22%、16.67%与16.67%;鲍氏不动杆菌对亚胺培南、头孢他啶、磺胺甲VA唑/甲氧苄啶有较高的敏感性,耐药率均为25.00%;金黄色葡萄球菌、表皮葡萄球菌对万古霉素与替考拉宁有较高的敏感性;表皮葡萄球菌、肺炎链球菌与粪肠球菌对替考拉宁的耐药率均为0。结论医院心脏外科患者感染病原菌以铜绿假单胞菌为主,该病原菌对广谱抗菌药物耐药性有加强趋势,因此,强化该类感染的临床监测,根据患者标本药敏结果合理选择抗菌药物对提高患者的治疗效果、减轻用药压力具有重要意义。
[Abstract]:Objective to investigate the current situation of pathogenic bacteria infection in patients with cardiac surgery in hospital, and to analyze the drug resistance of pathogens and the selection and application of antimicrobial agents in patients. Methods 200 patients with cardiac surgery from June 2015 to June 2016 were selected. The drug resistance of bacteria and the use of antimicrobial agents were investigated retrospectively and the rationality and correlation of drug selection were analyzed. Results there were 35 cases of infection after operation in 200 patients, and the infection rate was 17.5%. 92 strains of pathogenic bacteria were cultured in infected patients, 53 strains were Gram-negative bacteria (57.61%), among which 18 strains were Klebsiella pneumoniae, 19.57 strains were Klebsiella pneumoniae. There were 33 strains of Gram-positive cocci (35.87%), of which 17 strains were staphylococcus aureus (18.48%). Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli were highly sensitive to imipenem, and the drug resistance rates were 22.22% 16.67% and 16.67%, respectively. Acinetobacter baumannii had high sensitivity to imipenem, ceftazidime, sulfamethazol / trimethoprim, and the resistance rate was 25.00. Staphylococcus aureus and Staphylococcus epidermidis had high sensitivity to vancomycin and teicoplanin; The resistance rate of Staphylococcus epidermidis, Streptococcus pneumoniae and Enterococcus faecalis to teicoplanin was 0.Conclusion Pseudomonas aeruginosa is the main pathogen of hospital cardiac surgery. The antibiotic resistance of the pathogen to broad-spectrum antimicrobial agents has a tendency to strengthen, therefore, to strengthen the clinical monitoring of this type of infection, according to the results of drug sensitivity of patients with the reasonable selection of antimicrobial agents to improve the efficacy of patients. Reducing drug pressure is of great significance.
【作者单位】：武汉亚洲心脏病医院心外科;
【分类号】：R654
【正文快照】： 的后果。流行病学研究显示,虽然深部胸骨切口感染的发病率为0.60%~2.00%,但是30天病死率却高达10.30%~25.80%[1]。临床中,与心脏外科手术患者术后发生多药耐药菌感染相关的报道较多,相关感染防控报道显示,对于感染部位、病原菌分布及耐药性的研究是必要的前提与基础[2]。有研

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