体外膜肺氧合并发血流感染病原菌及耐药性分析  

Analysis of pathogens and antibiotics resistance of bloodstream infection in patients undergoing extracorporeal membrane oxygenation

作　　者：李茜[1] 孙仁华[1] 洪军[1] 胡秀平[1] 呼邦传[1] 公方晓[1] 

机构地区：[1]浙江省人民医院重症医学科,浙江杭州310014

出　　处：《中国现代医生》2015年第30期18-21,共4页China Modern Doctor

基　　金：浙江省科技厅重点科技创新团队项目(2011R50018-10);吴阶平医学基金(320.6750.14261)

摘　　要：目的了解重症医学科(ICU)中体外膜肺氧合(ECMO)治疗过程中并发血流感染病原菌的分布、耐药性特点以及可能的发病危险因素。方法选择2006年9月~2015年6月接受ECMO治疗并确诊发生血流感染的患者,对血培养分离到的病原菌进行鉴定和药敏学分析,并分析评价感染发生可能的危险因素。结果 ECMO患者发生血流感染的血培养共分离出7株病原菌,其中革兰阴性(G^-)杆菌5株,占71.4%,革兰阳性(G^+)球菌2株,占28.6%;G-杆菌如肺炎克雷伯菌肺炎亚种、乙酸钙鲍氏复合不动杆菌、铜绿假单胞菌及大肠埃希菌对各种常用抗菌药物耐药严重,2株G^+球菌分别为表皮葡萄球菌和头状葡萄球菌,对苯唑西林均耐药,但对万古霉素均敏感。ECMO时间≥7 d、置管部位出血等有可能是ECMO并发血流感染的危险因素。结论 G^-杆菌是ECMO治疗中并发血流感染的主要病原菌,且对多种抗菌药物耐药,G^+球菌敏感性尚可,应根据病原学及药敏结果合理用药,ECMO治疗期间应对发生血流感染的可能危险因素应实行重点监控并积极避免。Objective To investigate pathogens,antibiotics resistance and the probable risk factors of bloodstream infec tion in patients undergoing extracorporeal membrane oxygenation （ECMO） in our intensive care unit （ICU）. Methods Blood samples collected from patients undergoing ECMO from September 2006 to June 2015 in ICU received bacterial culture and antibiotics sensitive test. The risk factors related to bloodstream infection in ECMO were identified and evaluated. Results 7 strains of pathogens had been isolated by culture and 5 of which were Gram negative bacilli （71.4%）. 2 strains are Gram positive cocci （28.6%）. Gram negative bacilli include Klebsiella pneumoniae, Acinetobac- ter calcoaceticus-baumannii, Escherichia coli and Pseudomonas aeruginosa. Most of the Gram negative bacilli were highly resistant to many kind of antibiotics. 2 strains Gram positive cocci were Staphylococcus epidermidis and Staphy- lococcus capitis. They were both Meticillin-resistant and all sensitive to Vancomycin. The duration of ECMO I〉7 days, bleeding at the catheter site et al were probably the risk factors for bloodstream infection during ECMO. Conclusion Gram negative bacilli are the main pathogen of bloodstream infection during ECMO, and they are highly resistant to the most antibiotics agents. There are still some antibiotics sensitive to Gram positive cocci separated. The choice of antibiotics should be according to the pathogens antibiotics sensitivity test. The probable risk factors of bloodstream in- fection should be key-monitored and actively avoided.

关 键 词：体外膜氧合作用 血流感染 病原 抗生素耐受性 危险因素 

分 类 号：R563.8[医药卫生—呼吸系统]