山东大学齐鲁医院金黄色葡萄球菌血流感染发生率、菌株耐药性、抗菌药物使用及预后变化  

Changes of the incidence,antibiotic resistance,antibiotic therapy and prognosis in patients with Staphylococcus aureus bloodstream infection in Qilu Hospital of Shandong University

作　　者：崔毅[1] 尹梅[2] 李伟[3] 李远[1] 韩辉[1] 单悌超[1] 岳金凤[1] 丁士芳[1] 李琛[1] 陈晓梅[1] 吴大玮[1] 王昊[1] CUI Yi;YIN Mei;LI Wei;LI Yuan;HAN Hui;SHAN Tichao;YUE Jinfeng;DING Shifang;LIChen;CHEN Xiaomei;WU Dawei;WANG Hao(Intensive Care Unit,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Geriatrics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Laboratory,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院重症医学科,山东济南250012 [2]山东大学齐鲁医院老年病科,山东济南250012 [3]山东大学齐鲁医院检验医学科,山东济南250012

出　　处：《山东大学学报（医学版）》2018年第12期33-38,共6页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81501786);山东省自然科学基金(ZR2017PH050);山东省医药卫生科技发展计划(2015WS0291);济南市临床医学科技创新计划(201503010)

摘　　要：目的探讨近年来山东大学齐鲁医院金黄色葡萄球菌血流感染(SABI)发生率、菌株耐药性、抗菌药物治疗及预后转归的变化情况。方法回顾性分析2009年1月至2010年12月、2015年1月至2016年12月入住山东大学齐鲁医院并发生SABI的患者资料(分别为17、32例,作为甲组、乙组),采集病原学、实验室及临床指标,计算SABI发生时急性生理与慢性健康II(APACHEⅡ)评分和序贯脏器衰竭评分(SOFA),比较不同年度SABI的发生率、菌株耐药率、抗菌药物治疗情况、病情转归和28d病死率。结果与2009至2010年相比,2015至2016年SABI发生率(1.5‰vs 1.1‰)、28 d病死率(29.1%vs 18.8%)均下降,但差异无统计学意义(P均>0.05);患者的一般情况(性别、年龄、住院时间、科室分布、基础疾病)、住院花费、原发感染灶和病情严重程度(机械通气、肾脏替代治疗比例、感染性休克发生率及APACHE II、SOFA评分)等指标差异均无统计学意义(P均>0.05)。与2009至2010年相比,2015至2016年SABI患者所分离的致病菌中耐甲氧西林金黄色葡萄球菌(MRSA)所占比例升高,但差异无统计学意义(P>0.05),对青霉素、环丙沙星、万古霉素、利奈唑胺等的耐药率差异均无统计学意义(P均>0.05),无万古霉素、利奈唑胺耐药株出现;在目标性抗菌治疗中,糖肽类抗菌药物使用率显著提高(χ~2=5.244,P=0.022),而β内酰胺类抗菌药物使用率显著下降(χ~2=4.895,P=0.027)。结论近8年来,山东大学齐鲁医院SABI的发生率和28 d病死率呈下降趋势,但MRSA分离率升高,糖肽类抗菌药物使用愈加普及。Objective To investigate the changes of the incidence,antibiotic resistance,antibiotic therapy and prognosis in patients with Staphylococcus aureus bloodstream infection( SABI) in Qilu Hospital of Shandong University in recentyears. Methods The basic information of patients with SABI were retrospectively collected from January 2009 to December 2010( 17 cases,A group) and from January 2015 to December 2016( 32 cases,B group). The pathogen,laboratory and clinical data were also collected. Acute Physiology and Chronic Health Evaluation II( APACHEⅡ) score and Sequential Organ Failure Assessment( SOFA) score were then calculated. The incidence of SABI,the incidence of antibiotic resistance,antibiotic treatment,patient outcome and 28-day mortality were compared between these two groups. Results Compared with A group,the incidence and 28-day mortality of SABI in B group decreased( 1.5‰ vs1.1‰; 29.1% vs 18.8%) with no statistical difference( both P>0.05) in our hospital. The difference between the two groups in the basic information of SABI patients( including sex,age,length of stay,distribution of departments and primary diseases),hospitalization cost,primary source of bloodstream,and the severity of illness( including the rate of mechanical ventilation and renal replacement therapy,the incidence of septic shock,APACHE II score and SOFA score) were not statistically significant( all P > 0. 05). The proportion of methicillin-resistant Staphylococcus aureus( MRSA) in isolates increased with no statistical difference( P>0.05). The resistance rates of the isolates to penicillin,ciprofloxacin,vancomycin and linazolamide did not differ significantly( all P> 0.05). No vancomycin or linezolid resistant strains were found in the both groups. The patients in A group received significantly more antibiotic therapy of glycopeptide antibiotics and less antibiotic therapy of β-lactamase antibiotics for targeted antimicrobial therapy compared with B group( χ^2= 5.244,P = 0.022; χ^2= 4.895,P = 0.027). Conclusion In the recent 8

关 键 词：金黄色葡萄球菌 血流感染 抗菌药物 细菌耐药性 预后 

分 类 号：R515[医药卫生—内科学]