医院感染性发热患者血流感染病原菌分布及抗菌药物使用情况分析  

Distribution of pathogens causing bloodstream infection and use of antibiotics in patients with infectious fever

作　　者：范蓉[1] 武智聪[1] 杨淑岭[2] 李玉雪[1] 张华俐[1] FAN Rong;WU Zhicong;YANG Shuling(The First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院,050011 [2]河北省石家庄市第五医院

出　　处：《河北医药》2019年第21期3345-3347,3351,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展支撑计划项目(编号:151460833)

摘　　要：目的了解医院感染性发热患者血流感染的病原菌特点及抗菌药物使用情况,为临床合理高效选药提供依据。方法应用WHONET 5.6对药敏结果进行统计分析,应用Excel 2007软件对抗菌药物种类、用法用量、生化指标等信息进行记录、汇总。结果 9 228份血培养标本中共分离到446株病原菌,检出率为4.8%,其中有55.2%的革兰阴性菌,34.8%的革兰阳性菌及10.0%真菌。大肠埃希菌及肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率为0.6%~4.5%,未发现耐万古霉素和利奈唑胺葡萄球菌及肠球菌。23例病例出现血常规或生化指标异常,1例应用万古霉素出现皮疹、另有1例应用头孢他啶出现过敏性休克。结论医院感染性发热患者血流感染以革兰阴性杆菌为主,大肠埃希菌对碳青霉烯类药物的耐药率低,敏感率高,未发现耐万古霉素、利奈唑胺及替考拉宁的菌株经验性用药应结合本院的病原菌分布及耐药情况,可以防止细菌耐药率的进一步增加,并可提高治疗效果。Objective To investigate the distribution of pathogens causing bloodstream infection and use of antibiotics in patients with infectious fever so as to provide the evidence for rational clinical drug use. Methods The drug sensitivity results were statistically analyzed by using WHONET 5.6, and the species,usage and biochemical indexes of antibiotics were recorded by Excel 2007. WHONET 5.6 was used to analyze the results of drug sensitivity.Excel 2007 software was used to record the information of the types,usage and biochemical indexes of antibiotics.Results A total of 446 pathogenic bacteria were isolated from 9228 strains of blood culture specimens.The detection rate was 4.8%,including 55.2% gram negative bacteria,34.8% gram positive bacteria and 10% fungi.Moreover,the resistant rate of Escherichia coli and Klebsiella pneumoniae to the carbapenem antimicrobial agents was 0.6%~4.5%.No resistance to vancomycin and linezolid in staphylococcus aureus and enterococcus was found. In addition,23 cases of blood routine or biochemical abnormalities were found, the appearance of rash was found in 1 case after the application of vancomycin and anaphylactic shock appeared in 1 case after the application of cephalosporin ceftazidime. Conclusion Empirical drug use should be combined with the distribution and drug resistance of pathogenic bacteria so as to prevent the further increase in the rate of bacterial drug resistance and improve the curative effect.

关 键 词：血流感染 病原菌 耐药 抗菌药物 

分 类 号：R195[医药卫生—卫生统计学]