应用于重度烧伤患者的中央静脉导管病原菌分布及耐药性分析  

Distribution and drug resistance on pathogens isolated from central venous catheters utilized in severe burned patients

作　　者：许广瑜[1] 张烽[2] 潘宇红[2] 程华莉[2] 林萍萍[2] 陈蓉芳[2] 

机构地区：[1]南通大学附属第三医院门诊部,江苏无锡214041 [2]南通大学附属第三医院检验科

出　　处：《现代预防医学》2013年第14期2674-2678,2682,共6页Modern Preventive Medicine

基　　金：无锡市社会发展计划项目(CSZ00829)

摘　　要：目的了解某院烧伤重症监护室导管相关性感染的发生情况。方法对来源于重度烧伤患者的437例中央静脉导管标本进行病原菌分离培养,保留来源于同一患者中央静脉导管的不同种菌株及药敏谱不相同的同种菌株。Vitek 2 compact微生物鉴定分析仪鉴定菌种,KB法测定对药物的敏感性。结果共有118个导管分离到129株细菌(29.52%,129/437),其中革兰阳性细菌占31.78%(41/129),革兰阴性细菌占61.24%(79/129),真菌占6.98%(9/129)。革兰阳性和阴性细菌对大部分抗生素耐药率高。有22名患者使用的中央静脉导管中分离到了2株以上的非重复菌株,其中7名患者在不同时间分离到的同种细菌耐药谱存在差异。结论革兰阳性和阴性细菌对各类抗生素耐药严重,病原菌分布与该院分离自烧伤重症监护室患者的病原菌分布大致保持一致,提示中央静脉导管可能在烧伤重症监护室患者的医院感染中发挥了作用。不同时间分离到耐药谱不同的同种细菌可能与细菌变异及耐药基因的水平转移有关。烧伤重症监护室医师需注意严格监控和规范使用中央静脉导管。OBJECTIVE To investigate catheter related infections in the burn intensive care unit in our hospital. METHODS Pathogens isolated from 437 central venous catheters specimen were cultured. Distinct species and identical species with different drug resistance spectra, isolated from central venous catheters utilized in identical patients were reserved. The pathogens were identified by the Vitek 2 compact system and susceptibility tests were detected by KB method. RESULTS 129 （29.52%, 129 / 437） bacteria were isolated from 118 catheters and 31.78% （41 / 129） were gram-positive bacteria, 61.24% （79 / 129） were gram-negative bacteria and 6.98% （9 / 129） were fungus. The drug resistant rates to most antibiotics of grampositive bacteria and gram-negative bacteria both were high. Two or more non-repeated strains were isolated from the catheters utilized in 22 patients and drug resistance spectra of identical species isolated from 7 patients at different times were distinct. CONCLUSIONS Gram-positive bacteria and gram-negative bacteria both were resistant to most antibiotics. The distribution of pathogens isolated from catheters was identical to the pathogens isolated from patients in the burn intensive care unit , which indicated that central venous catheters might play a key role in nosocomial infections of the patients in the burn intensive care unit. The isolation of identical species isolated from identical patients at different times might be relevant to the bac-terial variation and the horizon transmission of the drug resistant genes. Rigid monitoring and formal application of central venous catheters should be noticed by doctors in the burn intensive care unit.

关 键 词：中央静脉导管 烧伤 耐药性 

分 类 号：R387[医药卫生—医学寄生虫学]