尿毒症患者血液透析所致导管相关性血流感染的细菌培养和药敏分析  

Analysis on bacterial culture and drug sensitivity of catheter-related bloodstream infection in hemodialysis patients with uremia

作　　者：伍梦寒 徐艺文 艾霜兰[1] 刁永书[1] WU Meng-han;XU Yi-wen;AI Shuang-lan(Nephrology Department of West China Hospital Affiliated to Sichuan University,Sichuan Chengdu 610041,China)

机构地区：[1]四川大学华西医院肾脏内科,四川成都610041

出　　处：《中国医学装备》2020年第4期110-113,共4页China Medical Equipment

摘　　要：目的:对尿毒症患者血液透析所致导管相关性血流感染(CRBSI)的细菌培养和药敏结果进行分析,为合理用药提供参考。方法:选取医院收治的81例导管CRBSI的尿毒症患者,所有患者均采用中心静脉置管(CVC)血管通路维持性血液透析治疗,根据收集分析患者的血培养结果和药敏结果,将其分为革兰阳性球菌组(59例)和革兰阴性杆菌组(22例)。对比分析两组患者的临床特征。结果:在81例患者中革兰阳性球菌感染59例(占72.8%),其中金黄色葡萄球菌(40.7%)和表皮葡萄球菌(12.3%)占比较高;革兰阴性杆菌感染22例(占27.2%),其中大肠埃希菌(8.6%)、阴沟杆菌(6.2%)和铜绿假单胞菌(4.9%)占比较高。对革兰阳性球菌耐药率较高的为青霉素G、克林霉素和红霉素,分别为94.9%、55.9%和54.2%;对革兰阴性杆菌耐药率较高的为氨苄西林、头孢替坦、头孢唑啉和氨苄西林/舒巴坦,耐药率分别为86.4%、68.2%、63.6%和59.1%。革兰阳性球菌组患者白细胞计数高于革兰阴性杆菌组,而C反应蛋白低于革兰阴性杆菌组,其差异有统计学意义(t=2.101,t=-2.460;P<0.05)。结论:尿毒症患者发生CRBSI的病原菌以革兰阳性球菌为主,金黄色葡萄球菌和表皮葡萄球菌占比较高,早期可行经验性抗感染治疗,待血培养和药敏结果检出后进行相应调整。Objective: To analyze bacterial culture and medicine sensitivity results of catheter-related bloodstream infection(CRBSI) of patients with uremia that was caused by hemodialysis so as to provide reference for reasonable using medicine. Methods: A total of 81 uremic patients with CRBSI were collected. All patients were treated with vascular pathway of central venous catheterization(CVC) for maintenance hemodialysis. According to the collected results of blood culture and medicine sensitivity, they were divided into Gram-positive coccus group(n=59) and Gramnegative bacilli group(n=22). The clinical characteristics of the two groups were compared and analyzed. Results: Among the 81 patients, 59 cases were Gram-positive coccus(72.8%), of which Staphylococcus aureus(40.7%) and Staphylococcus epidermidis(12.3%) accounted for relatively higher. Gram-negative bacilli infection occurred in 22 cases(27.2%). Among them, Escherichia coli(8.6%), Aerobacter cloacae(6.2%) and Pseudomonas aeruginosa(4.9%) accounted for relatively higher. The resistance rates of Gram-positive coccus were higher for Penicillin G, Clindamycin and Erythromycin, which were 94.9%, 55.9% and 54.2%, respectively. And the resistance rates of Gram-negative bacilli were higher for Ampicillin, Cefotetan, Cefazolin and Ampicillin/Sulbactam, and these were 86.4%, 68.2%, 63.6% and 59.1%, respectively. The number of white blood cells of patients in Gram-positive coccus group was significantly higher than that in Gram-negative bacilli group, while C-reactive protein of that was significantly lower than that in Gramnegative bacilli group(t=2.101, t=-2.460, P<0.05). Conclusion: Gram-positive coccus is the main pathogens of uremic patients with CRBSI, and the ratios of Staphylococcus aureus and Staphylococcus epidermidis are relatively higher. Empirically anti-infective treatment is feasible in the early stage, and then it should be correspondingly adjusted after the results of blood culture and medicine sensitivity are obtained.

关 键 词：血液透析 尿毒症 导管相关性血流感染(CRBSI) 细菌培养 药敏分析 

分 类 号：R692.5[医药卫生—泌尿科学]