导管相关性血流感染的病原菌分布及耐药分析  

Distribution and Drug Resistance of Pathogens Causing Intravascular Catheter-related Bloodstream Infections

作　　者：李少增[1] 朱静[1] 王海滨[1] 

机构地区：[1]解放军总医院第一附属医院检验科,北京100048

出　　处：《标记免疫分析与临床》2015年第1期28-30,36,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的分析我院血管内导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌构成及耐药分析,为临床治疗提供依据。方法对本院2010年1月至2014年5月确诊的91例CRBSI的107株病原菌进行回顾性分析。结果 6688例患者中91例为CRBSI的确诊病例,占1.4%,主要来源于ICU、烧伤科、肾内科和急救部;107株病原菌中,革兰阳性菌占28.0%(30株),以葡萄球菌为主,其中凝固酶阴性葡萄球菌占12.1%(13株),金黄色葡萄球菌占10.2%(11株),对万古霉素、利奈唑胺和替加环素的敏感率均达100%;非发酵的革兰阴性菌占63.6%(68株),其中病原菌分离率最高的是洋葱伯克霍尔德菌、鲍曼不动杆菌和铜绿假单胞菌,分别占20.6%、12.1%和12.1%,非发酵菌的多药耐药较严重;真菌占8.4%(9株),其中白色念珠菌对氟康唑、伊曲康唑、两性霉素B、5-氟胞嘧啶均敏感,但光滑念珠菌和克柔念珠菌有不同程度的中介和耐药。结论葡萄球菌属、非发酵革兰阴性杆菌和念珠菌属是本院CRBSI的主要病原菌,重视病原菌的监测,指导临床合理用药对控制CRBSI非常重要。Objective To analyze the distribution and drag resistance of pathogens causing intravascular catheter- related bloodstream infections （ CRBSI）, and provide doctors with laboratory evidence of CRBSI diagnosis. Methods A retrospective analysis of 107 strains of CRBSI pathogens＇ distributions from 91 inpatients whose catheter culturing was positive. Results There were 91 （ 1.4% ） patients diagnosed as CRBSI among 6688 cases. They were from ICU, Bums Branch, Department of Nephrology and Emergency Room. A total of 107 strains of pathogens, gram-positive bacteria accounted for 28% （30 strains）, 12.1% （ 13 strains） of which were coagulase-negative Staphylococcus, 10. 2% （ 1 lstrains ） of which were Staphylococcus anreus, the susceptibility rates to vancomycin, linezolid and tigecycline of Staphylococcus arrived at 100%, non-fermenting gram-negative bacteria accounted for 63.6% （68 strains）. The first three by rank order of the CRBSI pathogens were Burkholderia cepacia （20.6%）, Acinetobacter baumannii （12.1% ）, Pseudomonas aeruginosa （ 12.1% ）. The multi-drug resistant was more serious in non-fermenting bacteria, fungi accounted for 8.4% （9 strains） , and in which Candida albicans were sensitive to fluconazole, itraconazole, amphotericin B and 5- fluorocytosine. However, C. glabrata and C. krusei had different degrees of intermediaries and antimicrobial drugs. Conclusion CRBSI＇ major pathogens are Candida species, attaching importance to pathoge of CRBSI and rational using clinical antibiotics. Staphylococcus, non-fermenting Gram-negative bacteria and n and drug sensitivity inspection can guide controlling bacteria

关 键 词：导管相关性血流感染 病原菌分布 耐药 

分 类 号：R446.5[医药卫生—诊断学]