尿毒症维持性血液透析患者肺部感染病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens causing pulmonary infections in uremia patients undergoing maintenance hemodialysis

作　　者：李莉红[1] 邓孝陵[2] 陈以莲[3] 赵黎[4] 

机构地区：[1]武汉市普爱医院院感科,湖北武汉430033 [2]武汉市普爱医院肾内科,湖北武汉430033 [3]武汉市普爱医院消化科,湖北武汉430033 [4]湖北医药学院附属东风医院肾内科,湖北十堰442008

出　　处：《中华医院感染学杂志》2015年第17期3875-3877,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅基金资助项目(WJ01564)

摘　　要：目的探讨尿毒症维持性血液透析(MHD)患者肺部感染病原菌分布和耐药性,为降低该类患者医院感染率提供指导。方法对1997年7月-2014年3月41例尿毒症MHD患者的临床资料进行回顾性分析,采用法国生物梅里埃公司VITEK-2Compact全自动微生物鉴定仪器对标本进行分离、培养与细菌鉴定,并采用K-B纸片琼脂扩散方法进行抗菌药敏试验,采用SPSS17.0软件进行统计分析。结果 41例尿毒症MHD患者共发生52例次肺部感染,痰液培养阳性39例,共检出41株病原菌,革兰阴性菌23株占56.10%,革兰阳性菌14株占34.15%,真菌4株占9.75%;检出的革兰阴性菌对妥布霉素、亚胺培南耐药率较低,<40.00%,革兰阳性菌对三代头孢、喹诺酮类和万古霉素耐药率较低,<50.00%,真菌对氟康唑耐药率为0。结论尿毒症MHD患者的肺部感染以革兰阴性菌感染为主,且对常用抗菌药耐药率高,应根据药敏试验结果合理选用抗菌药物进行抗感染治疗。OBJECTIVE To explore the distribution and drug resistance of pathogens causing pulmonary infections in the uremia patients undergoing maintenance hemodialysis so as to provide guidance for reduction of incidence of nosocomial infections in this group of patients.METHODS The clinical data of 41 uremia patients who underwent the maintenance hemodialysis from Jul 1997 to Mar 2014 were retrospectively analyzed.The specimens were cultured,the pathogens were isolated and identified by using VITEK-2Compact automatic microorganism identification system of BioMerieux,France.The drug susceptibility testing was carried out by using K-B disk agar diffusion method,and the statistical analysis was performed with the use of SPSS 17.0software.RESULTS Of the 41 uremia patients undergoing the maintenance hemodialysis,52case-times had the pulmonary infections,and the sputum specimens were cultured positive in 39 cases.A total of 41 strains of pathogens were isolated,including 23（56.10%）strains of gram-negative bacilli,14（34.15%）strains of gram-positive cocci,and 4（9.75%）strains of fungi.The drug resistance rates of the isolated gram-negative bacteria to tobramycin and imipenem were less than40.00%;the drug resistance rates of the gram-positive bacteria to the third generation cephalosporins,quinolones,and vancomycin were less than 50.00%;the drug resistance rate of the fungi to fluconazole was 0.CONCLUSIONThe gram-negative bacilli are dominant among the pathogens causing the pulmonary infections in the uremia patients undergoing the maintenance hemodialysis and are highly resistant to the commonly used antibiotics.It is necessary to reasonably use antibiotics based on the results of the drug susceptibility testing.

关 键 词：尿毒症 维持性血液透析治疗 肺部感染 病原菌分布 耐药性 

分 类 号：R378[医药卫生—病原生物学]