心脏外科术后多重耐药细菌感染的病原学特征与耐药性分析  

Etiological characteristics and drug resistance in people with multi-drug resistant bacterial infection after cardiac surgery

作　　者：任建伟 温明修 张建业 刘玉磊[3] 朱光发[1] Ren Jianwei;Wen Mingxiu;Zhang Jianye;Liu Yulei;Zhu Guangfa(Department of Respiratory and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Cardiac Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Clinical Laboratory,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院呼吸与危重症医学科,北京100029 [2]首都医科大学附属北京安贞医院心脏外科中心,北京100029 [3]首都医科大学附属北京安贞医院微生物检验室,北京100029

出　　处：《中华微生物学和免疫学杂志》2023年第10期740-748,共9页Chinese Journal of Microbiology and Immunology

基　　金：国家自然科学基金(81970067)。

摘　　要：目的了解心脏外科术后患者多重耐药菌(multidrug-resistant organism,MDRO)感染的病原学特征以及耐药模式,指导临床医生合理应用指南推荐的抗菌药物,提高经验性抗菌治疗的成功率、改善住院患者预后。方法收集2018年1月—2021年10月心脏外科术后409例确诊为医院感染患者的完整病历资料,根据合格的临床标本阳性培养结果分为多重耐药细菌感染组(MDR=176例)和非多重耐药细菌感染组(non-MDR=233例),分析MDRO感染的病原学特征以及对临床常用抗菌药物的耐药模式,同时对不同的外科手术类型和临床感染类型相对应的病原学分布、耐药情况以及临床结局进行统计分析。结果合格的临床标本检出多重耐药细菌306株,97例(97/176,55.1%)患者同时存在两种及两种以上多重耐药细菌感染,主要表现为肺炎克雷伯菌、鲍曼不动杆菌和(或)铜绿假单胞菌混合感染,其中包括碳青霉烯类耐药细菌213株(213/306,69.6%)。无论外科手术类型和临床感染类型如何,病原学分布均以鲍曼不动杆菌(114/306,37.3%)最常见,其次是肺炎克雷伯菌(72/306,23.5%)和铜绿假单胞菌(55/306,18.0%),而且大部分的临床标本来源于痰液(528/601,87.9%),通常表现为碳青霉烯类耐药、多重耐药和泛耐药,尤以冠状动脉旁路移植手术和主动脉大血管手术最严重,多重耐药细菌分离率分别高达53.7%和53.1%,全耐药细菌的分离率相对较低。体外药敏结果显示多重耐药细菌对左氧氟沙星(64.4%)、头孢吡肟(61.4%)耐药率最高,其次是环丙沙星(54.6%)、头孢他啶(53.9%)、复方新诺明(52.4%);而多黏菌素(5.5%)和阿米卡星(7.2%)耐药性较低。与非多重耐药细菌感染相比较,感染多重耐药细菌对头孢他啶(χ^(2)=156.663,P<0.001)、头孢曲松(χ^(2)=27.844,P<0.001)、头孢吡肟(χ^(2)=210.181,P<0.001)、亚胺培南(χ^(2)=173.242,P<0.001)、左氧氟沙星(χ^(2)=201.521,P<0.001)、环丙沙星(χ^(2)=180.187,P<0.ObjectiveTo investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism(MDRO)infection in patients after cardiac surgery,so as to help clinicians rationally prescribe antimicrobials recommended by guidelines,increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.MethodsClinical data of 409 patients diagnosed with nosocomial infection(NI)after cardiac surgery from January 2018 to October 2021 were retrospectively collected.According to the results of culture,these cases were divided into two groups:MDR bacterial infection group(MDR,n=176)and non-MDR bacterial infection group(non-MDR,n=233).The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed.Meanwhile,the etiological distribution,drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed.ResultsA total of 306 strains of MDR bacteria were detected.Among the 176 patients,97(55.1%)were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae,Acinetobacter baumannii and/or Pseudomonas aeruginosa.Carbapenem-resistant(CR)bacteria accounted for 69.6%(213/306).Regardless of surgical type and clinical infection type,Acinetobacter baumannii(114/306,37.3%)was the most common pathogenic bacteria,followed by Klebsiella pneumoniae(72/306,23.5%)and Pseudomonas aeruginosa(55/306,18.0%).Most of the clinical specimens were sputum specimens(528/601,87.9%)and most of the isolated strains were carbapenem resistant,MDR and extensively drug-resistant(XDR).The positive rates of MDR bacteria were 53.7%and 53.1%in patients undergoing coronary artery bypass grafting(CABG)and aortic surgery,respectively,while the positive rates of pandrug-resistant bacteria were relatively low.In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin(64.4%)and cefepi

关 键 词：心脏外科术后 感染 多重耐药细菌 病原学特征 耐药模式 

分 类 号：R654.2[医药卫生—外科学] R446.5[医药卫生—临床医学]