急诊患者血流感染的病原菌分布及耐药性单中心回顾性分析  

A single-center retrospective study of pathogen distribution and antibiotic resistance of bloodstream infections in emergency department

作　　者：唐亦舒 陈丽华[2] 肖洁[1] 颜鲲[1] 漆靖 周柯夫[1] 刘怀政[1] TANG Yishu;CHEN Lihua;XIAO Jie;YAN Kun;QI Jing;ZHOU Kefu;LIU Huaizheng(Department of Emergency,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Laboratory Medicine,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院急诊科,长沙410013 [2]中南大学湘雅三医院检验科,长沙410013

出　　处：《中南大学学报(医学版)》2024年第11期1799-1807,共9页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2023JJ30830)。

摘　　要：目的:急诊患者血流感染发生率高、病情危重、进展迅速,及早使用敏感抗菌药物对改善患者预后至关重要。本研究探讨急诊患者血流感染的发生率、病原菌分布及耐药情况,为临床合理使用抗菌药物提供参考。方法:收集2018年1月至2022年10月在湖南地区某医院急诊科收治的血流感染患者的病历资料,分析血流感染患者的临床资料,同时分析临床分离菌株的分布与药敏试验结果。结果:研究期间急诊科一共送检2215个血培养标本,血培养阳性率为13.27%。排除资料缺失及怀疑标本污染的患者8例,纳入286例血流感染患者,以社区获得性感染为主(85.66%),感染部位以泌尿系统感染(24.48%)最常见,其次为呼吸系统感染(20.28%)、胆道及腹腔感染(17.13%)等。发生血流感染患者30 d病死率为16.08%。共分离出286株病原菌,其中革兰氏阴性菌181株(63.29%),主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌;革兰氏阳性菌101株(35.31%),主要为金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌;真菌仅4株(1.40%)。药敏试验结果显示:主要肠杆菌科细菌对碳青霉烯类、哌拉西林钠他唑巴坦钠、头孢他啶的耐药率分别为2.4%、16.3%、15.3%,暂未发现对替加环素和多黏菌素耐药的肠杆菌。主要非发酵菌对哌拉西林钠他唑巴坦钠、头孢哌酮钠舒巴坦钠和喹诺酮类抗菌药物耐药率分别为29.6%、13.3%和21.7%。革兰氏阴性菌中多重耐药菌占比为40.9%(74/181),耐碳青霉烯类大肠杆菌、肺炎克雷伯菌检出率分别为5.4%(5/92)和13.6%(6/44);未检出对碳青霉烯类耐药铜绿假单胞菌。革兰氏阳性菌对青霉素G、利福平、头孢西丁的耐药率分别为74.7%、4.2%、50%,仅3例对糖肽类抗菌药物耐药。结论:急诊患者血流感染以社区获得性感染为主,病原学上以革兰氏阴性菌为主,分离出的病原菌对临床常用抗生素耐药率相对较低。Objective:Bloodstream infections in emergency patients have a high incidence,severe disease progression,and rapid deterioration.Early administration of appropriate antimicrobial agents is crucial for improving patient outcomes.This study aims to investigate the incidence,pathogen distribution,and antimicrobial resistance patterns of bloodstream infections in emergency patients,providing a reference for rational antibiotic use in clinical practice.Methods:Medical records of patients diagnosed with bloodstream infections in the emergency department of a hospital in Hunan Province between January 2018 and October 2022 were retrospectively collected.Clinical characteristics of bloodstream infection patients were analyzed,and the distribution trends and antimicrobial susceptibility of clinical isolates were examined.Results:During the study period,2215 blood culture samples were submitted from the emergency department,with a positivity rate of 13.27%.After excluding eight cases with missing data or suspected contamination,286 patients with bloodstream infections were included,with community-acquired infections accounting for the majority(85.66%).The most common primary infection site was the urinary tract(24.48%),followed by respiratory tract infections(20.28%)and biliary and intra-abdominal infections(17.13%).The 30-day mortality rate of bloodstream infections was 16.08%.A total of 286 pathogens were isolated,including 181(63.29%)Gram-negative bacteria,primarily Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa;101(35.31%)Gram-positive bacteria,mainly Staphylococcus aureus,Staphylococcus epidermidis,and Streptococcus pneumoniae;and only 4(1.40%)fungal isolates.Antimicrobial susceptibility testing showed that the key Enterobacteriaceae strains exhibited resistance rates of 2.4%to carbapenems,16.3%to piperacillin sodium and tazobactam sodium,and 15.3%to ceftazidime,with no detected resistance to tigecycline or polymyxins.The main non fermentative bacteria showed resistance rates of 29.6%to piperacillin

关 键 词：急诊科 血流感染 病原菌 耐药性 流行病学 

分 类 号：R446.5[医药卫生—诊断学]