摘要
目的分析医院住院患者发生混合血流感染的病原学特点、耐药性及预后相关因素,为临床治疗提供依据。方法对2008年8月-2015年12月发生混合血流感染216例患者的病例资料及微生物检查结果进行数据收集,应用Whonet5.6进行耐药分析。结果混合血流感染的发生以外科为主占40.28%,其中肝胆外科占19.91%;共分离442株病原菌,依次是111株肠球菌属,占25.11%、83株大肠埃希菌,占18.78%、69株肺炎克雷伯菌,占15.61%;病原菌组合有45种,以6种组合为主;大肠埃希菌未出现碳氢酶烯类耐药菌株,对阿米卡星和哌拉西林/他唑巴坦较敏感;肺炎克雷伯菌对亚胺培南耐药率为10.14%;铜绿假单胞菌对抗菌药物的耐药率均低于30.00%;鲍氏不动杆菌对绝大多数抗菌药物耐药率均高达80.00%以上;屎肠球菌的耐药率普遍高于粪肠球菌,屎肠球菌对万古霉素的耐药率为3.45%,粪肠球菌未检出对万古霉素耐药的菌株。结论混合血流感染的治疗应根据不同组合中病原菌的耐药性合理选用药物进行治疗,同时严格监测药物敏感性。
OBJECTIVE To investigate the etiological characteristics of mixed bloodstream infection in hospitalized patients,analyze the drug resistance,and explore the related factors for prognosis so as to provide guidance for clinical treatment.METHODS The medical records were collected from 216 patients who had mixed bloodstream infection from Aug 2008 to Dec 2015,the results of microbiological examination were analyzed,and the drug resistance was observed by using Whonet5.6software.RESULTS Of the patients who had the mixed bloodstream infection,40.28% were in department of surgery,and 19.91% were isolated from department of hepatobiliary surgery.A total of 442 strains of pathogens were isolated,of which 25.11%（111strains）were Enterococcus spp,18.78%（83strains）were Escherichia coli,15.61%（69strains）were Klebsiella pneumoniae.There were 45 pathogen combinations patterns,of which 6mixed pathogen were dominant pattern.There was no carbapenem-resistant E.coli strains,and the E.coli strains were highly susceptible to amikacin and piperacillin-tazobactam;the drug resistance rate of the K.pneumoniaeto imipenem was 10.14%;the drug resistance rate of the P.aeruginosa was less than 30.00%;the drug resistance rate of the Acinetobacter baumannii to most of the antibiotics was more than 80.00%;the drug resistance rate of the E.faecium was generally higher than that of the E.faecalis;the drug resistance rate of the E.faeciumto vancomycin was 3.45%;and the vancomycin-resistant E.faecalis strains were not detected.CONCLUSIONIt is necessary to reasonably use antibiotics according to the drug resistance of the different combinations of pathogens causing the mixed bloodstream infection and strictly monitor the drug susceptibility at the same time.
作者
叶丽艳
袁培
马艳宁
沈跃云
张永轻
马薇
罗燕萍
YE Li-yan YUAN Pei MA Yan-ning SHEN Yue-yun ZHANG Yong-qing MA Wei LUO Yan-ping(PLA General Hospital, Beijing 100853, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第4期750-753,共4页
Chinese Journal of Nosocomiology
基金
军队"十二五"课题(AWs11c001)
关键词
血流感染
混合菌感染
耐药分析
Bloodstream infection
Mixed bacterial infection
Analysis of drug resistance
