2014-2019年某医院血流感染患者的临床特征和病原学分析  

Clinical characteristics and etiological analysis of patients with bloodstream infection in a hospital from 2014 to 2019

作　　者：李丽[1] 金力[1] 朱咏臻 乔丹[1] 周敏[1] Li Li;Jin Li;Zhu Yong-zhen;Qiao-Dan;Zhou Min(Department of Laboratory Medicine,Ruijin Hospital North,Shanghai Jiao Tong University School of Medicine,Shanghai 201801)

机构地区：[1]上海交通大学医学院附属瑞金医院北部院区检验科,上海201801

出　　处：《中国抗生素杂志》2022年第1期84-89,共6页Chinese Journal of Antibiotics

基　　金：上海交通大学医学院附属瑞金医院北部院区院基金项目(No.2018ZY06)。

摘　　要：目的分析血流感染(bloodstream infection,BSI)患者的临床特征和病原菌情况,为BSI治疗和院内感染防控提供依据。方法回顾性分析2014年8月—2019年7月上海交通大学医学院附属瑞金医院北部院区BSI住院患者的临床和病原学资料,采用Whonet 5.6软件进行耐药统计。结果196例患者发生BSI,男132例,平均年龄62岁;90.8%患者有基础疾病,59.2%有侵袭性操作史,41.8%有局部感染灶,所有患者均发热,主要来自重症监护室、普外科和血液科。共分离病原菌208株,其中革兰阴性菌113株(54.3%)、革兰阳性菌73株(35.1%)、真菌21株(10.1%),分离率最高的为肺炎克雷伯菌,其次为凝固酶阴葡萄球菌(CNS)、大肠埃希菌、鲍曼不动杆菌、金黄色葡萄球菌、粪肠球菌和屎肠球菌等。CNS和金黄色葡萄球菌对甲氧西林耐药率分别为89.7%和37.5%,分离的所有革兰阳性菌对万古霉素、利奈唑胺和替加环素100%敏感;大肠埃细菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)检出率分别为56.7%和58.1%,大肠埃细菌对碳青霉烯类无耐药;肺炎克雷伯菌对替加环素耐药率较低(7.1%),对亚胺培南和美罗培南耐药率分别为34.1%和45.2%;鲍曼不动杆菌对临床常用抗菌药物耐药率较高,对亚胺培南和美罗培南耐药率分别为57.1%和66.7%。结论患者的年龄、基础疾病、侵袭性操作史和局部感染灶等因素可能与血流感染发生有关,本研究血流感染病原菌以革兰阴性菌为主,肺炎克雷伯菌和鲍曼不动杆菌对包括碳青霉烯类在内的多种常用抗菌药物耐药率较高。Objective To analyze the clinical characteristics and pathogenic bacteria of patients with bloodstream infection(BSI),so as to provide evidence for clinical anti BSI treatment and nosocomial infection prevention and control.Methods The clinical and etiological data of hospitalized patients with BSI from August 2014 to July 2019 were retrospectively analyzed.The drug resistance was analyzed by Whonet 5.6 software.Results Among 196 patients,132 were male,average age of 62 years.90.8%had basic diseases,59.2%had invasive operation history,41.8%had local infection focus,all patients had fever,the patients mainly came from intensive care unit,general surgery and hematology department.A total of 208 pathogen germs were isolated,including 113 Gram-negative bacteria(54.3%),73 Gram-positive bacteria(35.1%)and 21 fungi(10.1%).The most common pathogens were Klebsiella pneumoniae,coagulase negative Staphylococcus,Escherichia coli,Acinetobacter baumannii,Staphylococcus aureus,Enterococcus faecalis and Enterococcus faecium.The resistance rates of CNS and Staphylococcus aureus to methoxycillin were 89.7%and 37.5%,respectively.The Gram-positive strains were 100%sensitive to vancomycin,linezolid and tegacyclin.The detection rates of ESBLs of E.coli and Klebsiella pneumoniae were 56.7%and 58.1%,respectively.The resistance rates of E.coli to cefoperazone/sulbactam,piperacillin/tazobactam and cefotetan were less than 10%,and no resistance to carbapenems.The resistance rate of Klebsiella pneumoniae to tigecycline was low(7.1%),the resistance rates to imipenem and meropenem were 34.1%and 45.2%,respectively.Acinetobacter baumannii has a high resistance rate to commonly used antibiotics,the resistance rates to imipenem and meropenem were 57.1%and 66.7%,respectively.Conclusion The age of patients,the presence or absence of basic diseases,the history of invasive operation and local infection foci were all related to the occurrence of bloodstream infection.Gram-negative bacteria are the main pathogens of bloodstream infection in this study,

关 键 词：血流感染 临床特征 血培养 病原菌分布 耐药性 

分 类 号：R978.1[医药卫生—药品]