老年血流感染患者107例病原菌分布和药敏分析  

Etiological and antibiotic resistance profile of bloodstream infections in 107 old patients

作　　者：查翔远[1] 宋有良[1] 金正胜[1] 沈智勇[1] 王谦[1] 胡晓春[1] 

机构地区：[1]安徽省铜陵市人民医院感染科,安徽铜陵244009

出　　处：《中国感染与化疗杂志》2017年第1期77-81,共5页Chinese Journal of Infection and Chemotherapy

基　　金：铜陵市卫生和计划生育委员会科研项目资助课题(卫科研[2015]5号);安徽省临床医学应用技术项目(2008A058)

摘　　要：目的探讨老年患者血流感染(BSI)的病原微生物学特征。方法回顾性分析2015年1—12月铜陵市人民医院所有年龄≥65岁且确诊为BSI住院患者的临床及血培养资料。结果 107例患者中分离病原菌107株(剔除重复菌株)。其中社区获得性感染患者占57.9%(62/107),医院获得性感染患者占42.1%(45/107);社区获得性BSI分离细菌中革兰阴性菌占67.7%,医院获得性BSI中革兰阳性菌占55.5%。老年男性继发于呼吸系统感染者多于老年女性(P<0.001),老年女性继发于泌尿系统感染者多于老年男性(P<0.001)。分离的病原菌中,革兰阴性菌59株,占55.1%,革兰阳性菌45株,占42.1%,真菌3株,占2.8%。检出率居前6位的依次为大肠埃希菌(30.9%)、凝固酶阴性葡萄球菌(20.6%)、金黄色葡萄球菌(金葡菌)(10.3%)、肺炎克雷伯菌(6.5%)、肠球菌属(6.5%)、不动杆菌属(4.7%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β内酰胺酶(ESBL)株分别占51.5%和28.6%;大肠埃希菌对阿米卡星、头孢西丁及哌拉西林-他唑巴坦耐药率在10%以下,对碳青霉烯类无耐药;肺炎克雷伯菌仅对替加环素尚无耐药,对碳青霉烯类耐药率达14.3%~28.6%。甲氧西林耐药金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)检出率分别为各自菌种的36.4%和72.7%。未发现耐万古霉素、替考拉宁和利奈唑胺葡萄球菌;检出1株耐万古霉素屎肠球菌。结论老年患者BSI病原菌以革兰阴性菌为主,大肠埃希菌和凝固酶阴性葡萄球菌是最常见的病原菌。应重视性别、原发感染部位等因素对老年患者BSI的影响。Objective To investigate the etiological and antibiotic resistance profile in the old patients with bloodstream infection （BSI）. Methods Microbiological and clinical data were collected and reviewed retrospectively for the patients with confirmed bloodstream infection and at least 65 years of age who were treated as inpatients in Tongling People＇s Hospital from January to December 2015. Results A total of 107 strains of pathogen were isolated from the blood samples of 107 patients with bloodstream infections, of which community-acquired BSI accounted for 57.9 % （62/107）, and hospital-acquired BSI 42.1% （45/107）. Gram negative bacilli accounted for 67.7 % in the pathogens of community-acquired BSI and gram positive cocci accounted for 55.5 % in the pathogens of hospital-acquired BSI. More male BSI patients were secondary to respiratory tract infection than female patients （P〈0.001）, while more female BSI patients were secondary to urinary tract infection than male patients （P〈0.001）. Of the 107isolates, gram negative bacilli, gram positive cocci and fungi accounted for 55.1% （59/107）, 42.1% （45/107） and 2.8% （3/107）, respectively. The top six pathogens were E. coli （30.9 %）, coagulase negative Staphylococcus （CNS） （20.6 %）, S. aureus （10.3 %）, K. pneumoniae （6.5%）, Enterococcus spp. （6.5 %） and Acinetobacter spp. （4.7 %）. About 51.5 % of the E. coli isolates and 28.6 % of the K. pneumoniae isolates produced extended-spectrum β-1actamases （ESBLs）. E. coli isolates showed low resistance rate （〈 10%） to amikacin,cefoxitin and piperacillin-tazobactam. No E. coli isolate was found resistant to carbapenem. About 14.3 % to 28.6 % ofK. pneumoniae isolates were resistant to carbapenems. No tigecycline-resistant K. pneumoniae was found. The prevalence of MRSA and MRCNS was 36.4% and 72.7 %, respectively. No staphylococcal isolates were found resistant to vancomycin, teicoplanin or linezolid. One strain of E. faecium was identified as resistant to v

关 键 词：老年人 血流感染 抗菌药物 细菌耐药性监测 多重耐药菌 

分 类 号：R446.5[医药卫生—诊断学] R515.3[医药卫生—临床医学]