机械通气患者中心静脉导管相关性血流感染革兰阴性杆菌分布及耐药性分析  

Distribution and drug resistance of gram-negative bacilli causing central venous catheter-related bloodstream infections in patients undergoing mechanical ventilation

作　　者：王伟华[1] 郑逸华[1] 徐利萍[1] 林雪梅[1] 林建青[1] 徐文芳[1] 徐林燕[1] 

机构地区：[1]江山市人民医院呼吸内科,浙江江山324100

出　　处：《中华医院感染学杂志》2013年第24期6150-6151,6154,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅科研基金项目(2011KYA166)

摘　　要：目的观察机械通气患者中心静脉导管相关血流感染(CRBSI)革兰阴性杆菌分布及其耐药性的特点,为临床治疗提供依据。方法于2011-2013年对机械通气患者中心静脉导管可疑出现相关血流感染标本进行培养及药敏试验,分析其病原菌分布和耐药性特点。结果 48例机械通气患者CRBSI革兰阴性杆菌中,主要细菌分别为大肠埃希菌13株占27.1%、肺炎克雷伯菌10株占20.8%、铜绿假单胞菌8株占16.7%、鲍氏不动杆菌6株占12.5%;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌检出率为42.5%、肺炎克雷伯菌检出率40.8%;革兰阴性杆菌对常用抗菌药物耐药率高,对碳青霉烯类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿米卡星等敏感性较高。结论机械通气患者CRBSI的革兰阴性杆菌耐药现象严重,应加强病原学及耐药性监测,合理使用抗菌药物,减少耐药性的发生。OBJECTIVE To observe the distribution and drug resistance of the gram-negative bacilli causing central venous catheter-related bloodstream infections （CRBSI） in the patients undergoing mechanical ventilation so as to guide the clinical treatment. METHODS From 2011 through 2013, the culture of specimens and the drug susceptibility testing were performed for the patients with suspected CRBSI who underwent the mechanical ventilation, then the distribution and drug resistance of the pathogens were analyzed. RESULTS Of all the gram-negative bacilli isolated ＇from 48 cases of CRBSI, there were 13 （27. 1%） strains of Escherichia coli, 10 （20.8%） strains of Klebsiella pneumoniae, 8 （16.7%） strains of Pseudomonas aeruginosa, and 6 （12.5%） strains of Acinetobacter baumannii. The detection rates of the extended-spectrum β-lactamase （ESBLs）-producing E. coli and K. pnuernoniae were 42.5% and 40.8%, respectively. The gram-negative bacilli were highly resistant to the commonly used antibiotics but were highly susceptible to carbapenems, piperacillin-tazobactam, cefoperazone-sulbactam, and amikacin. CONCLUSION The gram-negative bacilli causing CRBSI in the patients undergoing mechanical ventilation are highly resistant; it is necessary to strengthen the monitoring of etiology and drug resistance and reasonably use antibiotics so as to reduce the incidence of drug resistance.

关 键 词：机械通气 中心静脉导管相关血流感染 革兰阴性杆菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]