368例血流感染患者临床特征、病原与耐药性研究  

Clinical Characteristics,Pathogens and Drug Resistance of 368 Patients with Bloodstream Infection

作　　者：楼颂羔 钱卫星 张瑜芳 Lou Song-gao;Qiang Wei-xing;Zhang Yu-fang(Shengzhou Hospital of Traditional Chinese Medicine,Shengzhou Zhejiang 312400;Shengzhou People's Hospital,Shengzhou Zhejiang 312400)

机构地区：[1]嵊州市中医院,嵊州浙江312400 [2]嵊州市人民医院,嵊州浙江312400

出　　处：《国外医药（抗生素分册）》2024年第1期50-55,共6页World Notes on Antibiotics

基　　金：嵊州市级科技计划项目(2020-64-NF-29)。

摘　　要：目的探讨血流感染(BSI)患者临床特征、病原分布与耐药性,为抗菌药物合理使用提供参考。方法调查研究2020年07月—2021年6月期间入住嵊州市两家公立医院确诊为血流感染所有成年患者共368例,分为社区获得BSI与医院获得BSI两组,记录患者人口学资料、临床特征、细菌及药敏结果。结果感染来源前三位分别为腹腔(38.6%)、泌尿道(27.2%)、皮肤软组织及骨关节(9.5%);27例(7.3%)处于免疫抑制状态;173例(47.0%)有近期抗菌药物暴露史。社区获得BSI组腹腔来源比例高于医院获得BSI组(P=0.010),静脉导管来源、免疫抑制状态、抗菌药物暴露比例,APACHEⅡ、PBS评分则低于医院获得BSI组(P<0.05)。368例患者共检出379株细菌,其中革兰阳性球菌108株(28.5%)、革兰阴性杆菌247株(65.2%)、厌氧菌13株(3.4%)、念珠菌属10株(2.6%);检出率前三位细菌依次为大肠埃希菌、肺炎克雷伯菌和肠球菌属,分别占30.1%、18.7%、9.8%;社区获得BSI组大肠埃希菌检出率高于医院获得BSI组(P<0.001),而肠球菌属、非发酵菌和念珠菌属检出率则低于后者(P<0.05)。耐甲氧西林金黄色葡萄球菌(MRSA)比例占43.3%;大肠埃希菌对头孢曲松耐药率为51.8%、肺炎克雷伯菌对亚胺培南耐药率为22.5%。医院获得BSI组肺炎克雷伯菌对氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢曲松、头孢他啶、头孢替坦、氨曲南、亚胺培南和妥布霉素耐药率高于社区获得BSI组(P<0.05)。309例(84.0%)治疗有效,59例(16.0%)无效。血流感染发生后28 d死亡率为14.1%(52/368),医院获得BSI组死亡率高于社区获得BSI组(P<0.05);初始广谱抗菌治疗病例中35.5%(78/220)5 d内实施了降阶梯策略,其中降阶梯组死亡率低于非降阶梯组,(P<0.05)。结论本地区BSI病原菌以革兰阴性菌为主,大肠埃希菌和肺炎克雷伯菌是前二位病原菌;医院获得性BSI大肠埃希菌检出率显著减少,非发酵菌、念珠菌检出率�Objective The purpose of this research is to investigate the drug resistance,pathogen distribution,and clinical characteristics of patients with bloodstream infections(BSI)and to offer a resource for the prudent use of antibiotics.Methods Between July 2020 and June 2021,a total of 368 adult patients with BSI from two governmental hospitals in Shengzhou City were examined and classified into two groups:those who acquired their BSI in the community and those who acquired it in the hospital.The demographic data,clinical characteristics,and bacterial and drug sensitivity results of the patients were recorded.Results Intra-abdominal(38.6%),urinary tract(27.2%),and skin,soft tissue,bone,and joint(9.5%)were the top three causes of infection.7.3%,or 27 instances,had immunosuppression.47.0%,or 173 instances,have previously used antibiotics.The proportion of intra-abdominal sources in the community-acquired BSI group was higher than that in the hospital-acquired BSI group(P=0.010),the proportion of intravenous catheter source,immunosuppressive status,antibiotic exposure,APACHEⅡand PBS scores were lower(P<0.05).A total of 379 strains of bacteria were detected,among which 108(28.5%)were Gram-positive cocci,247(65.2%)were gram-negative bacilli,13(3.4%)were anaerobes and 10(2.6%)were Candida.The top three bacteria were Escherichia coli,Klebsiella pneumoniae and Enterococcus,accounting for 30.1%,18.7%and 9.8%,respectively.The proportion of Escherichia coli in the community-acquired BSI group was higher(P<0.001)while the proportion of Enterococcus,non-fermentable bacteria and Candida was lower(P<0.05).Methicillin-resistant strains(MRSA)accounted for 43.3%.The resistance rates of Escherichia coli to ceftriaxone and Klebsiella pneumoniae to imipenem were 51.8%and 22.5%,respectively.Compared with the community-acquired BSI group,the resistance rate of Klebsiella pneumoniae in the hospital-acquired BSI group to ampicillin/sulbactam,piperacillin/tazobactam,ceftriaxone,ceftazidime,cefotetan,amtriannan,imipenem and tobramycin was hig

关 键 词：血流感染 临床特征 病原菌 体外药敏 抗菌治疗 降阶梯 

分 类 号：R978.1[医药卫生—药品]