机械通气患者导管相关性血流感染革兰阳性球菌分布与耐药性分析  

Distribution and drug resistance of gram-positive cocci causing catheter-related bloodstream infections in patients undergoing mechanical ventilation

作　　者：王伟华[1] 郑逸华[1] 徐利萍[1] 林雪梅[1] 林建青[1] 徐文芳[1] 徐林燕[1] 李振华[1] 王栩轶[2] 

机构地区：[1]江山市人民医院呼吸内科,浙江江山324100 [2]解放军总医院心胸外科,北京100853

出　　处：《中华医院感染学杂志》2015年第22期5100-5102,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2011KYA166)

摘　　要：目的分析机械通气患者导管相关性血流感染(CRBSI)革兰阳性球菌的耐药性,以指导临床合理使用抗菌药物。方法采集2014年医院机械通气并行中心静脉置管可疑出现导管相关性血流感染患者的血液标本,采用VITEK-32全自动微生物分析系统进行细菌鉴定和药物敏感试验,总结其病原菌分布和耐药性特征。结果 50例机械通气CRBSI患者送检标本共检出革兰阳性球菌58株,前3位分别为凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌属,分别占58.6%、24.1%、13.8%;检出耐甲氧西林凝固酶阴性葡萄球菌占64.7%,耐甲氧西林金黄色葡萄球菌占85.7%,凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌属对万古霉素、替考拉宁和利奈唑胺敏感率均为100.0%。结论机械通气患者CRBSI革兰阳性球菌对常用抗菌药物耐药现象严重,磺胺甲噁唑/甲氧苄啶和利福平对凝固酶阴性葡萄球菌及金黄色葡萄球菌有较好的抗菌活性,未发现对万古霉素、替考拉宁和利奈唑胺的耐药菌株,需加强病原学及耐药性监测。OBJECTIVE To investigate the drug resistance of gram‐positive cocci causing catheter‐related blood‐stream infections （CRBSI） in the patients undergoing mechanical ventilation so as to provide guidance for reasona‐ble clinical use of antibiotics .METHODS The blood specimens were collected from the patients with suspected CRBSI who underwent the mechanical ventilation and were treated with central venous catheterization ,then the bacterial identification was carried out by using VITEK‐32 automatic microorganism analysis system ,the drug susceptibility testing was performed ,and the distribution and drug resistance of the pathogens were observed . RESULTS A total of 58 strains of gram‐positive cocci were isolated from the submitted specimens that were ob‐tained from the 50 CRBSI patients undergoing the mechanical ventilation ;the coagulase‐negative Staphylococcus , Staphylococcus aureus ,and Enterococcus spp ranked the first three places ,accounting for 58 .6% ,24 .1% ,and 13 .8% ,respectively .The isolated methicillin‐resistant coagulase‐negative Staphylococcus strains accounted for 64 .7% ,and the methicillin‐resistant S .aureus strains accounted for 85 .7% .The drug susceptibility rates of the coagulase‐negative Staphylococcus , S .aureus ,and Enterococcus spp to vancomycin ,teicoplanin ,and linezolid were 100 .0% .CONCLUSION The gram‐positive cocci isolated from the mechanical ventilation patients with CRBSI are highly resistant to the commonly used antibiotics ;sulfamethoxazole‐trimethoprim and rifampin show good anti‐bacterial activity against coagulase‐negative Staphylococcus and S .aureus;the strains resistant to vancomycin , teicoplanin ,or linezolid are not found .It is necessary to strengthen the surveillance of etiology and drug resistance .

关 键 词：机械通气 中心静脉置管 导管相关性血流感染 革兰阳性球菌 耐药性 

分 类 号：R378.1[医药卫生—病原生物学]