ICU肠球菌属血流感染危险因素及药敏分析  

Analysis of drug sensitivity and risk factors of Enterococcus bloodstream infections in ICU

作　　者：伍万[1] 江荣林[2] 马伟斌[2] 雷澍[2] 王灵聪[2] 智屹惠[2] 吴艳春[2] 黄立权[2] 朱美飞[2] 

机构地区：[1]浙江中医药大学第一临床医学院,浙江杭州310053 [2]浙江中医药大学附属第一医院,浙江杭州310006

出　　处：《中华医院感染学杂志》2014年第6期1367-1369,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析ICU患者肠球菌属血流感染的高危因素、临床表现、病原菌分布及药敏率,为临床诊治肠球菌属感染提供依据。方法回顾性分析2009年1月-2012年10月确诊肠球菌属血流感染47例患者的临床资料,所有标本均按《全国临床检验操作规程》的要求进行分离培养及鉴定,药敏结果按美国临床实验室标准化研究所抗菌药物敏感试验法规判定,使用SPSS17.0统计软件进行数据统计分析。结果肠球菌属血流感染47例患者中分离粪肠球菌25株、屎肠球菌17株、鹑鸡肠球菌5株,其中耐万古霉素肠球菌(VRE)4株;感染来源以中心静脉导管最多占78.7%,发生肠球菌属血流感染以中、重度发热、白细胞和中性粒细胞升高及多脏器功能不全为主要表现,37例确诊为导管相关性血流感染;肠球菌属对替考拉宁、利奈唑胺、替加环素的敏感率均为100.0%;对万古霉素的敏感率为91.5%,其中粪肠球菌为96.0%、屎肠球菌为94.1%、鹑鸡肠球菌为60.0%;经采用迅速拔除中心静脉导管,给予敏感抗菌药物治疗后,治愈率为95.7%。结论肠球菌属血流感染较多见的是导管相关性血流感染,菌种分布以粪肠球菌和屎肠球菌较多见,临床表现复杂,以中、重度炎症反应及多脏器功能不全为主,迅速拔除中心静脉导管和及时给予敏感抗菌药物,以提高治愈率。OBJECTIVE To investigate the risk factors, clinical manifestations, antibiotic susceptibility rate and treatment results infected by Enterococcus in ICU and provide clinicians information for the treatment of Enterococcuss infections. METHODS The clinical data of 47 cases of enterocoecal bacteremia in our ICU from Jan, 2009 to Oct, 2012 were analyzed retrospectively. RESULTS Among 47 cases, there were 25 cases of E. faecalis, 17 cases of E. faeciurn and 5 cases of Entcrococcus gallinarum. There were 4 cases of vancomycin resistant Enterococcus among these cases. Infection sources came from central venous catheter（CVC）（78.7%） and biliary tract. 68.1 % patients with enterococeal infections suffered from four or more underlying diseases, 76.6% patients with enterococcal infections have five or more high risk factors. Elevated white cells and neutrophils, moderate-to- severe fever and multiple organ dysfunction syndrome（MODS） were main clinical manifestations. 37 （78. 7%） cases were diagnosed catheter-related bloodstream infections（CRBSI） . Antibiotic of %-lactam and amino-glycosides were low susceptible rates to Enterococcus. The susceptible rates of Enterococcus to teicoplanin, linezolid and tigecyeline were all 100 %. The total susceptible rate of Enterococcus to vancomycin was 91.5%. The susceptible rates were 96. % （E. faecalis）, 94. 1% （E. faecium） and 60% （Entcrococcus Gallinarum） respectively. Therapeutic measures included immediately removing CVC and using susceptible antibiotics. The cure rate of patients with Enterococcal infection was 98.36 %. CONCLUSION Enterococcal bacteremia usually oceured in patients who suffered from multiple underlying diseases as well as high risk factors. E. faecalis and E. faecium were the most common flora. Enterococcal infection, VRE infection were rare and clinical manifestations were complex,while the main manifestation was the moderate to-severe inflammatory response and MODS. immediately removing CVC and using susceptible antibiotics can imp

关 键 词：重症监护病房 肠球菌属 血流感染 药敏率 

分 类 号：R978.1[医药卫生—药品]