589例尿毒症患者合并感染的菌群特点及药敏分析  

Analysis of bacterial flora and drug sensitivity in 589 patients with uremia complicated infection

作　　者：陈倩[1] 钟清[1] 江维[2] 李曼丽[1] 王辉[1] 向莎 Chen Qian;Zhong Qing;Jiang Wei;Li Manli;Wang Hui;Xiang Sha(Department of Nephrology,the First Afiliated Hospial of Chongqing Medical University,Chongqing 400042,China;Department of Infections Disease,the First ffiliated Hospital of Chongqing Medical U niversity,Chongqing 400042,China)

机构地区：[1]重庆医科大学附属第一医院肾脏内科,重庆400042 [2]重庆医科大学附属第一医院感染科,重庆400042

出　　处：《国际泌尿系统杂志》2021年第3期535-538,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨尿毒症合并感染患者的菌群分布及药敏特点,为预防与控制感染提供流行病学依据,指导临床合理选择抗菌药物,提高治疗效果,改善预后。方法选取2016年1月至2019年10月于本院住院治疗的慢性肾脏病(CKD)5期患者,筛选其中并发感染且病原微生物培养阳性的患者589例,对感染部位构成比、病原菌分布及药敏结果进行统计分析。结果病原微生物培养阳性的尿毒症患者中,常见感染部位依次为泌尿系统217例(36.8%)、呼吸道183例(31.1%)、导管相关性血流89例(15.1%)。感染的菌群中革兰阴性杆菌共260例(44.1%),以大肠埃希菌97例(16.5%)多见,革兰阴性杆菌耐药率:氨苄西林(85.5%)、头孢呋辛(62.6%);敏感率:替加环素(96.0%)厄它培南(94.1%)、亚胺培南(94.0%)、美洛培南(94.0%)。革兰阳性球菌共250例(42.4%),以金黄色葡萄球菌95例(16.1%)多见,革兰阳性球菌耐药率:青霉素(77.8%)、克林霉素(70.8%)、红霉素(70.6%);敏感率:替加环素(100.0%)、替考拉宁(100.0%)、达托霉素(100.0%)、利奈唑胺(99.0%)、万古霉素(98.4%)。真菌共71例(12.1%),以白假丝酵母菌32例(5.4%)多见,对两性霉素B完全敏感,对棘白素类抗真菌药物敏感率达80%以上,对唑类抗真菌药物的敏感率达70%以上。结论病原微生物培养阳性的CKD患者中,感染部位常以泌尿系、血液、呼吸道为主,其中革兰阴性杆菌与革兰阳性球菌感染多见,临床上应根据不同细菌感染及耐药情况合理使用抗生素,提高治疗效果,改.善患者预后。Objective To investigate the distibution of bacterial flora and drug susceptibility in patients with uremia for providing epidemiological basis for the prevention and control of infection,guiding the rational selection of clinical antibiotics,improving the treatment effect and the prognosis.Methods A total of 589 CKD5 stage patients hospitalized in our department from January 2016 to 0c-tober 2019 were selected and screened for concurrent infection and positive culture of pathogenic micro-organisms.SPSS 22.0 was used for statistical analysis of the proportion of infected sites,distribution characteristics of pathogenic bacteria and drug sensitivity results.Results Among the patients with uremia with positive culture of pathogenic microorganisms,the common infection sites were successive-ly 271 cases(36.8%)of urinary system,183 cases(31.1%)of respiratory tract,and 89 cases(15.1%)of catheter-related blood flow.There were 260 cases(44.1%)of gram-negative bacilli in the infectedflora,and 97 cases(16.5%)of escherichia coli were more common.The drug resistance rate ofgram-negative bacilli was ampicillin(85.5%),cefazolin(72.0%),cefuroxime(62.6%).Sensitivityrate:tegacycline(96.0%),imipenem(94.0%),melopenem(94.0%).There were 250 cases(42.4%)of gram-positive coccus,and 95 cases(16.1%)of staphylococcus aureus were more com-mon.The resistance rate of gram-positive coccus was penicillin(77.8%),clindamyein(70.8%),e-rythromycin(70.6%).Sensitivity rate:tegacycline(100%),teicolanin(100.0%),datoramycin(100.0%),linezolid(99.0%),vancomycin(98.4%).There were 71 cases(12.1%)of fungi,a-mong which 32 cases(5.4%)were mostly candida albicans,which were completely sensitive to am-photericin B,more than 80%to acanthopycin antifungal drugs,and more than 70%to azole antifungaldrugs.Conclusions In patients with uremia with positive culture of pathogenic microorganisms,themain infection sites are urinary system,blood and respiratory tract,among which gram-negative bacilliand gram-positive cocci infection are common.In clinical practice,antibiot

关 键 词：尿毒症 感染 病原 

分 类 号：R446.5[医药卫生—诊断学] R692.5[医药卫生—临床医学]