维持性血液透析患者医院感染病原菌及耐药性分析  

Distribution and drug resistance of pathogens causing nosocomial infections in maintenance hemodialysis patients

作　　者：张燕[1] 王文静[1] 王云霞[2] 

机构地区：[1]莱芜市人民医院血液透析室,山东莱芜271100 [2]莱芜市人民医院普外科,山东莱芜271100

出　　处：《中华医院感染学杂志》2014年第15期3668-3670,共3页Chinese Journal of Nosocomiology

基　　金：莱芜市科研基金项目[莱科鉴字(2009)127]

摘　　要：目的探讨维持性血液透析患者发生医院感染的病原学特点以及药物敏感性,以期在临床干预时选择敏感抗菌药物。方法选取医院收治的维持性血液透析患者123例,对可疑发生医院感染的患者取相应部位标本进行细菌培养和耐药性分析。结果 123例患者中发生医院感染76例、222例次,感染率30.89%、例次感染率90.24%;共分离出174株病原菌,检出标本以痰液为主占55.75%,其次为血液、尿液及粪便,分别占30.46%、10.34%及3.45%;革兰阴性菌对氨苄西林耐药率高达89.00%,对阿莫西林、一代头孢菌素和喹诺酮类药物亦普遍耐药,对二、三代头孢和磺胺类药物较为敏感,对亚胺培南和氨基苷类抗菌药物敏感性较高;革兰阳性菌对青霉素的耐药率高达93.10%,对红霉素、阿莫西林、一二代头孢菌素、喹诺酮类药物以及林可霉素普遍耐药,但是对三代头孢菌素、利福平、万古霉素和亚胺培南耐药性较低,而敏感性较高。结论不同感染部位病原菌分布不同,不同病原菌的耐药性也不同,在临床工作中一旦发现感染征象,应及时给予全面治疗,提高治愈率,降低患者病死率。OBJECTIVE To explore the etiological characteristics of nosocomial infections in the maintenance hemodialysis patients and analyze the drug susceptibility so as to choose susceptible antibiotics for clinical intervention. METHODS A total of 123 maintenance hemodialysis patients were enrolled in the study, then the patients with suspected nosocomial infections were sampled from corresponding sites for bacterial culture and analysis of drug resistance. RESULTS The nosocomial infections occurred in 76 of 123 patients （222 case-times） with the infection rate of 30. 89% and the case-time infection rate of 90.24%. A total of 174 strains of pathogens have been isolated, among which 55.75% were isolated from sputum specimens, 30.46% from blood specimens, 10.34% from urine specimens, 3.45M from feces. The drug resistance rate of the gram-negative bacteria to ampicillin was 89.00 %, the strains were widely resistant to amoxicillin, first generation eephalosporins, and quinolones but were susceptible to the second and third generation eephalosporins as well as sulfonamides, and the drug susceptibility rates to imipenem and aminoglycosides were high. The drug resistance rate of the gram-positive bacteria to penicillin was 93.10% ,the strains were widely resistant to erythromyein, amoxicillin, the first and second generation cephalo- sporins, quinolones, arid lincomyein, however, the drug resistance rates to the third generation cephalosporins, rifampicin, vancomycin, and imipenem were low. CONCLUSION The distribution of the pathogens causing infections in different sites is different, and the pathogens vary in the drug resistance. Once the infections occur in the clinical practice, it is necessary to perform comprehensive treatment so as to raise the cure rate and reduce the mortality rate.

关 键 词：血液透析 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]