带涤纶套隧道血液透析导管相关感染菌群分布及药敏分析  

Distribution and Drug Sensitivity Analysis of The Infection Bacteria in Hemodialysis Catheter Associatde with Polyester Tunnel

作　　者：邓洁尧[1] 黄胜[1] 李丽波[1] 

机构地区：[1]广东省南方医科大学附属南海医院,广东佛山528200

出　　处：《哈尔滨医药》2016年第2期146-148,共3页Harbin Medical Journal

基　　金：广东佛山市科技局医学类科技攻关项目(201308164)

摘　　要：目的回顾性分析佛山市南海区人民医院带涤纶套隧道血液透析导管相关感染资料,探讨感染常见菌群分布及对抗生素的耐药情况。方法对20例中心静脉留置导管相关性感染的患者进行血培养并对培养出的菌株测定其对常见抗生素的耐药性。结果 19例患者标本血培养阳性18例次,其中1例两种细菌阳性;,分泌物培养阳性1例;,共分离出5种病原菌。其中革兰氏阴性杆菌10例,占50%,革兰氏阳性杆菌10例,占50%。感染病原菌以金黄色葡萄球菌(50%)、阴沟肠杆菌(25%)为主。检出的10株金黄色葡萄球菌中有3株为耐甲氧西林金黄色葡萄球菌。对于革兰氏阴性杆菌,美罗培南、亚胺培南最为敏感。对于金黄色葡萄球菌最为敏感的抗生素为万古霉素和替考拉宁。有3例死亡病例,其中1例并发颅内脓肿。结论我院带涤纶套隧道血液透析导管相关感染多为金黄色葡萄球菌和阴沟肠杆菌;根据经验和药敏试验抗感染治疗效果好,要把握拔管时机,避免转化为脓毒血症的风险。Objective To analyze the distribution and drug resistance of athogens causing catheter- related infections in uremia patients undergoing hemodialysis so as to provide theoretical basis for reasonable clinical use of antibiotics. Methods Patients with tunneled catheter- related infection were enrolled in the study,then the transcatheter arterial end blood,venous blood,and peripheral blood were respectively sampled for routine vaccination and culture,the distribution and drug resistance of the pathogens were analyzed. Results Totally 20 strains of pathogens have been isolated through the bacterial culture,including 10（ 50%） strains of gram-positive bacteria and 10（ 50%） strains of gram- negative bacteria; the Staphylococ- cus aureus was the predominant species,accounting for 50% and the Enterobacter cloacae accounting for 25%. The drug resistance rate of the S. aureus to penicillin reached up to100. 00%; Carbapenems remained high activity against Gram negative bacteria; Vancomycin and Teicoplanin are high activity against the Staphylococ- cus aureus. Conclusion The gram- positive bacteria are the predominant pathogens causing the hemodialysis catheter-related infections; it is necessary to adjust the antibiotic therapy based on the drug susceptibility testing for the prevalent strains.

关 键 词：血液透析 感染 细菌耐药性 导管 涤纶套 

分 类 号：R961[医药卫生—药理学]