急性中毒合并感染患者的病原微生物分布特点及耐药性分析  

Distribution and drug resistance of pathogenic microorganisms isolated from patients with acute poisoning

作　　者：尹秀云 曾利军 徐建民 蒋虔 杨哲 李好莲 王文彩 李波 陈建魁 YIN Xiu-yun;ZENG Li-jun;XU Jian-min;JIANG Qian;YANG Zhe;LI Hao-lian;WANG Wen-cai;LI Bo;CHEN Jian-kui(Department of Clinical Laboratory,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071,China)

机构地区：[1]解放军总医院第五医学中心检验科,北京100071

出　　处：《军事医学》2022年第10期780-785,共6页Military Medical Sciences

基　　金：国家重大科学仪器设备开发专项(2012YQ18011708);国家军事标准课题(BWS18B091)。

摘　　要：目的 探讨急性中毒合并感染患者病原微生物分布特点及耐药情况,为其诊治和预防提供参考依据。方法回顾性研究2015-2020年急性中毒患者中毒种类和病原微生物感染等情况。结果 急性中毒最常见的是农药中毒,其次是药物中毒,患者感染部位以下呼吸道(69.8%)和泌尿道(18.2%)为主;1129株病原菌中,细菌占78.48%,真菌占21.52%。最常见病原菌种类依次为鲍曼不动杆菌、白色假丝酵母菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌;耐碳青霉烯类鲍曼不动杆菌(CRAB)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分离率较高,分别为80.6%和87.5%。药敏试验结果显示,非发酵鲍曼不动杆菌对常用抗菌药物,如碳青霉烯类、头孢三代、头孢四代、β-内酰胺类复合物和氟喹诺酮类的耐药率均>70%;肺炎克雷伯菌对碳青霉烯类、β-内酰胺类复合物的哌拉西林/他唑巴坦的耐药率较低,为8%~14%。常用抗菌药物中,头孢三代和四代、氟喹诺酮类对大肠埃希菌较为耐药,而对肺炎克雷伯菌则较为敏感。金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌未发现对万古霉素、利奈唑胺和替加环素耐药株。屎肠球菌中,VRE分离率为3.3%。真菌药敏结果显示,常见的假丝酵母菌属对两性霉素B和5-氟胞嘧啶的敏感率均为100%;氟康唑可作为除对氟康唑固有耐药的克柔假丝酵母菌外的假丝酵母菌属真菌的经验用药。结论 急性中毒患者以农药中毒为主,感染部位以下呼吸道为主,感染病原菌种类繁多,不同病原菌对抗菌药物耐药性存在差异。为提高急性中毒抢救成功率,必须重视中毒后相关细菌和真菌感染的诊断,并依据微生物鉴定和药敏试验结果,选择适宜抗生素和其他治疗药物,以达到最大限度挽救患者生命目的。Objective To investigate the distribution and drug resistance of pathogenic bacteria isolated from patients with acute poisoning so as to provide reference for the diagnosis,prevention and treatment of acute poisoning infections.Methods A retrospective analysis of pathogenic microorganism infections in patients with acute severe poisoning between2015 and 2020 was conducted. Results The most common type of acute poisoning was pesticide poisoning,followed by drug poisoning. The infection sites of acute poisoning were mainly the lower respiratory tract(69.8%)and urinary tract(18.2%). Among the 1129 strains of pathogenic bacteria,bacteria accounted for 78.48%,and fungi 21.52%. The most common pathogens were Acinetobacter baumannii,Candida albicans,Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli. CRAB and MRCNS had higher isolation rates,which were 80.6% and 87.5% respectively. The bacterial susceptibility results showed that the commonly used antibacterial drugs,such as carbapenems,third-generation cephalosporins,fourth-generation cephalosporins,β-lactam complexes and fluoroquinolones,were highly resistant to non-fermenting A.baumannii. The drug resistance rate was above 70%. The resistance rate of K.pneumoniae to carbapenems and β-lactam complexes of piperacillin/tazobactam was low,ranging from 8% to 14%. Among the commonly used antibacterial drugs,the third and fourth generations of cephalosporins and fluoroquinolones were more resistant to E.coli,but more sensitive to K.pneumoniae. Staphylococcus aureus,coagulase-negative Staphylococcus,and Enterococcus faecalis were found to be nonresistant to vancomycin,linezolid and tigecycline. In Enterococcus faecium,the VRE isolation rate was 3.3%. The fungal drug susceptibility results showed that the common Candida spp. were 100% sensitive to both amphotericin B and 5-flucytosine. Fluconazole could be used empirically for Candida species other than C.krusei,which was inherently resistant to fluconazole. Conclusion In this study,it has been found that th

关 键 词：急性中毒 毒物 细菌感染 真菌感染 抗生素 

分 类 号：R595[医药卫生—内科学]