系统性红斑狼疮患者医院感染病原菌分布与耐药性分析  

Species distribution and antimicrobial resistance characteristics of pathogenic bacteria causing nosocomial infections in patients with SLE

作　　者：陈纯洲 舒新华[1] 赵甲[2] 王顺[3] 

机构地区：[1]湖北省监利县人民医院皮肤科,湖北监利县433300 [2]湖北省监利县人民医院检验科,湖北监利县433300 [3]武汉市第一医院检验科,湖北武汉430022

出　　处：《中华医院感染学杂志》2015年第7期1509-1511,共3页Chinese Journal of Nosocomiology

基　　金：湖北省自然科学基金资助项目(2011CDB501)

摘　　要：目的研究系统性红斑狼疮(SLE)患者医院感染特点、病原菌种型及耐药特性,为诊治医院感染提供合理选药的依据。方法 2011年1月-2013年12月调取两所医院167份系统性红斑狼疮医院感染患者的病历资料;感染病原菌的分离培养、细菌种型鉴定依照临床细菌学检验的常规流程进行;药敏试验选择K-B法,数据分析启动WHONET 5.6程序,试验全过程坚持室内质量控制。结果 167例红斑狼疮患者发生医院感染192例次,感染部位以呼吸道感染为主占51.6%,其次为泌尿系感染占16.7%;分离的219株病原菌中,检出率较高的是肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌和金黄色葡萄球菌;耐甲氧西林葡萄球菌(MRS)检出率为51.4%,产超广谱β-内酰胺酶(ESBLs)菌株检出率为48.6%,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为19.5%、24.2%;革兰阴性菌耐药率>40.0%的抗菌药物有头孢噻肟、磺胺类药物、氟喹诺酮类药物和庆大霉素等。结论系统性红斑狼疮患者医院感染病原菌种属多样,其多药耐药现象日益严重,因此,医院应强化执行《抗菌药物临床应用管理办法》的力度,科学有序地使用抗菌药物,才能有望遏制细菌耐药性快速上升的不良现状。OBJECTIVE To understand the species and drug resistance characteristics of pathogenic bacteria causing nosocomial infections in patients with systemic lupus erythematosus（SLE）and offer the guidance for rational drug selection for treatment of nosocomial infections.METHODS Clinical records of 167 cases with SLE during Jan.2011 to Dec.2013 were investigated from two hospitals.Pathogenic cultures,isolation,species identification and antibiotic susceptibility test were performed according to microbiological routine methods and CLIS.Data were analyzed by WHONET 5.6.All tests were performed under quality control.RESULTS Totally 192 case times of nosocomial infections occurred in the 167 patients,which predominated by respiratory tract infections（51.6%）,followed by urinary infections（16.7%）.A total of 219 pathogenic bacteria were isolated from infective specimens,which predominated by Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumanii,Escherichia coli,and Staphylococcus aureus.The detection rate of methicillin-resistant Staphylococci,ESBLs,imipenem-resistant P.aeruginosa,A.baumanii were 51.4%,48.6%,19.5% and 24.2% respectively.Gran-negative bacteria showed resistance more than 40% to cefotaxime,sulfanilamides,fluoroquinolones and gentamycin.CONCLUSIONThere exist various species and multi-resistance of pathogenic bacteria causing nosocomial infections in SLE patients.Therefore,the hospital should strictly execute the Management of Clinical Application of Antibiotics and scientifically and orderly use antibacterial agents to control the dangerous status of increasing bacterial resistance.

关 键 词：系统性红斑狼疮 医院感染 病原菌 

分 类 号：R378[医药卫生—病原生物学]