静脉导管相关性血流感染病原菌分布及耐药性分析  

Analysis on the Relativity of Catheter-Related Bloodstream Infections of Pathogenic Bacteria Distribution and Drug Resistance

作　　者：牛丽辉[1] 

机构地区：[1]邯郸市中心医院检验科

出　　处：《现代检验医学杂志》2016年第2期120-123,126,共5页Journal of Modern Laboratory Medicine

摘　　要：目的探讨静脉导管相关性血流感染（CRBSI）的病原菌分布特点及耐药性，以指导临床合理用药。方法对2012年3月-2014年12月收集的332例静脉导管，使用VITEK—II全自动微生物鉴定系统进行菌种鉴定，K—B法进行抗菌药物敏感性试验分析。结果332例静脉导管中有127例培养阳性，阳性率为38．3％。127例阳性标本中，革兰阳性球菌45株（35．4％），革兰阴性杆菌66株（52．0％），真菌11株（8．7％），革兰阳性杆菌5株（3．9％）。革兰阳性球菌中以凝固酶阴性葡萄球菌、肠球菌及金黄色葡萄球菌为主，对万古霉素、替考拉宁、利奈唑胺敏感，对其它抗菌药物普遍耐药。耐甲氧西林金黄色葡萄球菌（MRSA）10株，检出率为100．00％，尚未发现耐万古霉素的肠球菌。革兰阴性菌中最常见的是鲍曼不动杆菌，其次为肺炎克雷伯菌和大肠埃希菌，检出的部分鲍曼不动杆菌耐药严重，仅对多黏菌素B和米诺环素（MH）敏感，检出的真菌对氟康唑耐药性有上升趋势。结论近三年来CRBSI病原体以鲍曼不动杆菌为主，各病原菌对抗生素耐药情况复杂，且耐药性较高。Objective To explore the distribution characteristics and drug resistance of intravenous catheter-related pathogenic bacteria of bloodstream infections （CRBSI） ,in order to guide clinical rational drug use. Methods In March 2012 to December 2014＇s collection of 332 cases of venous catheter, using VITEK-II automatic bacteria identification of microbial identification system,K-B method for antibacterial drug sensitivity test analysis. Results Venous catheter with 127 cases in 332 cases were positive, positive rate was 38.3 %. Of 127 positive specimens, 45 strains were gram-positive coccus accounting for 35.4 %, 66 strains were gram-negative bacilli accounting for 52.0 M, 11 were positive for fungi accounting for 8.7 %, 5 were positive for gram-positive bacilli accounting for 3.9 %. The main pathogens of the gram-positive coccus were coagulase negative Staphylococcus,Enterococcus and Staphylococcus aureus. They were sensitive to Vaneomyein,Teieoplanin and Linezolid,but they were general resistance to other antibacterial drugs. The detection rate about 10 strains of Methicillin-resistant Staphylococcus aureus （MRSA） was 100.00 %, had not found the pathogen bacteria that had drug resistant to VA vaneomycin resistant enterococcus. The most common pathogen of gram negative bacilli were Acinetobacter baumannii, Escherichia coil and Klebsiella pneurnoniae. The most Acinetobacter baumannii were deteeteved had drug recisitance seriously,only was sensitive to polymyxin B and MH and the resistance of fungi detected to itraconazole was on the rise. Conclusion The main pathogen bacteria of CRBSI was Acinetobacter baumannii in past three years. All sort of pathogen bacterias have complicated conditions and high resistance.

关 键 词：导管相关血流感染 病原菌 耐药性 

分 类 号：R446.65[医药卫生—诊断学]