医院获得性血流感染的临床与病原学分析  

Clinical and etiological study of nosocomial bloodstream infections

作　　者：刘海波[1] 朱光发[2] 王爱萍[3] 刘双[1] 

机构地区：[1]首都医科大学附属北京安贞医院感染科,北京100029 [2]首都医科大学附属北京安贞医院呼吸科,北京100029 [3]首都医科大学附属北京安贞医院检验科,北京100029

出　　处：《中国感染与化疗杂志》2013年第3期176-180,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解医院获得性血流感染(NBSI)患者的临床和病原学特征,为NBSI的预防和经验用药提供参考。方法回顾2009年1月—2011年12月在首都医科大学附属北京安贞医院住院并发生NBSI的患者临床资料,并对患者临床和病原学特征进行总结分析。结果入选患者324例,共发生NBSI 459例次,包括复数菌感染43例次(占9.3%)。分离各类病原微生物505株(去除重复菌株)。其中革兰阳性菌235株(46.5%),革兰阴性菌202株(40%),念珠菌68株(13.5%)。最常见的病原菌依次为凝固酶阴性葡萄球菌(CNS)125株(24.8%),鲍曼不动杆菌88株(17.4%),念珠菌68株(13.5%),金葡菌39株(7.7%),肺炎克雷伯菌31株(6.1%),大肠埃希菌30株(5.9%)和阴沟肠杆菌30株(5.9%)。CNS和金葡菌中甲氧西林耐药菌株分别占95.2%和79.5%。鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对头孢哌酮-舒巴坦敏感率分别为44.3%、53.3%、69.2%和70.8%,对亚胺培南敏感率分别为25.0%、83.3%、86.7%和96.8%。结论 NBSI中革兰阳性菌比率略高于革兰阴性菌,两者对常用抗菌药物耐药程度高。念珠菌在NBSI中占有重要地位。Objective To characterize the clinical feature, prevalence and antimicrobial susceptibility of pathogens isolated from the patients with nosocomial bloodstream infections （NBSIs）, and provide evidence for prevention and empirical antimicrobial therapy of NBSIs. Methods The clinical data of all patients who were diagnosed with nosocomial bloodstream infections based on national diagnostic criteria were retrospectively analyzed in Beijing Anzben Hopital, Capital Medical University from 2009 to 2011. Results During the 3-year study period, a total of 324 patients （male 203, female 121, mean 49.6 ± 26.6 years of age） were diagnosed with 459 episodes of NBSIs. A total of 505 strains were isolated from blood specimens. Gram-positive bacteria, gram-negative bacilli and Candida spp. accounted for 46.5 %, 40.0 % and 13.5 %, respectively. Coagulase negative Staphylococcus （CNS, 24.8%）, Acinetobacterbaurnanii （17.4%）, Candida spp. （13.5%）, Staphylococcus aureus （7. 7%）, Klebsiella pneumoniae （6.1 % ）, Escherichia coli （5.9 % ） and Enterobacter cloacae （5.9 % ） were frequently identified isolates. The prevalence of methicillin-resistant CNS and Staphylococcus aureus was 95.2 % and 79.5 %, respectively. The percentage of the Acinetobacter baumanii , Klebsiella pneumoniae , Escherichia coli and Enterobacter cloacae strains susceptible to cefoperazone sulbactam was44.3%, 53.3%, 69.2% and 70. 8%, respectively, while to imipenem, was 25.0%, 83. 3%, 86. 7% and 96.8%, respectively. Conclusions Gram positive cocci are slightly more prevalent than gram negative bacilli in nosoeomial bloodstream infections. Resistance to the commonly used antibiotics is common among all the pathogenic isolates. Candida spp. is the third leading cause of nosocomial bloodstream infections.

关 键 词：医院获得性血流感染 细菌 真菌 抗菌药物敏感性试验 预后 

分 类 号：R446.5[医药卫生—诊断学]