感染性无菌体液细菌分布及耐药性分析  

Analysis of Bacterial Distribution and Drug Resistance of Bacteria in Infectious Sterile Body Fluids

作　　者：秦立霞 李芳[1] 赵会海 QIN Li-xia;LI Fang;ZHAO Hui-hai(Department of Clinical Laboratory Medicine,980 Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇(白求恩国际和平)医院检验实验科,石家庄050082

出　　处：《临床误诊误治》2020年第3期77-82,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划(20150371)。

摘　　要：目的总结感染性无菌体液细菌分布及耐药性情况,为临床合理用药提供理论依据。方法回顾性分析420份感染性无菌体液阳性标本的细菌培养情况及药敏试验结果。结果所有患者均首次分离菌株,共检出菌株435株,其中革兰阳性球菌147株,革兰阴性杆菌271株,真菌17株。感染性无菌体液常见病原菌依次为大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌。血液检出菌株172株,脓液检出菌株82株,腹腔积液检出菌株75株,胆汁检出菌株55株,脑脊液检出菌株27株,胸腔积液检出菌株19株,引流液检出菌株4株,关节腔积液检出菌株1株。大肠埃希菌对阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的敏感率>90%,肺炎克雷伯菌对阿米卡星、妥布霉素的敏感率>90%,金黄色葡萄球菌和凝固酶阴性葡萄球菌均对β-内酰胺类、大环内酯类药物的耐药率较高,鲍曼不动杆菌对米诺环素和头孢哌酮/舒巴坦的耐药率较低,铜绿假单胞菌对多数抗菌药物较为敏感,粪肠球菌对呋喃妥因、环丙沙星、左氧氟沙星、氨苄西林及青霉素的耐药率明显低于屎肠球菌,但粪肠球菌对氯霉素、米诺环素、链霉素高耐和四环素的耐药率显著高于屎肠球菌。结论感染性无菌体液病原菌以革兰阴性杆菌为主,及时监测病原菌种类、分布和耐药情况以指导临床合理用药,可有效减少耐药性菌属的产生。Objective To summarize the distribution and drug resistance of bacteria in infectious sterile body fluids(SBF),and to provide the theoretical basis for rational drug use in clinical practice.Methods Bacterial culture and drug sensitivity test results of 420 positive specimens of infectious SBF were analyzed retrospectively.Results Bacterial strains were isolated from all patients for the first time,and a total of 435 bacterial strains were detected,including 147 Gram-positive cocci,271 Gram-negative bacilli,and 17 fungi.The most common pathogenic bacteria in infectious SBF were Escherichia coli,Klebsiella pneumoniae,and coagulase-negative staphylococcus.In addition,172 strains were detected in blood,82 in pus,75 in peritoneal effusion,55 in bile,27 in cerebrospinal fluid,19 in pleural effusion,4 in drainage fluid and 1 in joint cavity effusion.The sensitivity rate of escherichia coli to amikacin,piperacillin/tazobactam,cefoperazone/sulbactam was>90%,and klebsiella pneumoniae to amikacin and tobramycin was>90%.Both staphylococcus aureus and coagulase negative staphylococcus had higher drug resistance to the drugs ofβ-lactams and macrolides,acinetobacter baumannii had lower resistance to minocycline and cefoperazone/sulbactam,and pseudomonas aeruginosa was more sensitive to most antibiotics.The drug resistance rate of enterococcus faecalis to nitrofurantoin,ciprofloxacin,levofloxacin,ampicillin and penicillin was significantly lower,but its resistance rate to chloramphenicol,minocycline,streptomycin and tetracycline was significantly higher,as compared with that of enterococcus faecalis.Conclusion Gram-negative bacilli are the main pathogens of infectious SBF,and the species,distribution and drug resistance of pathogens should be monitored to guide the rational use of drugs and to effectively reduce the generation of drug-resistant bacteria.

关 键 词：细菌感染 抗生素耐药性 药物监测 体液 药物筛选试验 铜绿假单胞菌 亚胺培南 

分 类 号：R515[医药卫生—内科学]