败血症98例临床分析

目的：探讨近年来败血症病原菌变迁和对常用抗菌药物的敏感状况以及影响败血症预后的因素。方法：回顾性分析1998～2004年的98例经血培养和临床资料证实的败血症。结果：98例败血症患者血培养共分离出致病菌102株，属社区获得性败血症81例（82．7％），医院获得性17例（17．3％）。革兰阳性菌、革兰阴性菌和真菌感染分别占34．3％、60．8％、4．9％。社区获得性败血症以大肠埃希菌为主，其次是金黄色葡萄球菌和肺炎克雷伯菌。医院获得性败血症以大肠埃希菌、真菌和不动杆菌为主。23抹金葡菌中苯唑西林耐药率39．1％，未发现对万古霉素耐药的菌株；31株大肠埃希菌对氨苄西林、阿米卡星和左氧氟沙星耐药率分别占90．3％、61．3％和45．2％，但对头孢三代、四代及酶抑制剂耐药率较低（12．9％～19．1％），未发现对亚胺培南-西司他丁耐药菌株。院内感染、血小板下降、血糖升高及休克增加了败血症患者病死率。结论：院内感染败血症病原菌中真菌和不动杆菌呈上升趋势，大肠埃希菌和金葡菌感染首选亚胺培南-西司他丁和万古霉素，大肠埃希菌院外败血症可首选头孢三代或亚胺培南-西司他丁。

Clinical analysis of 98 cases of septicemia

Objectives:To identify the spectrum of pathogens causing septicemia and their resistance profiles,and to investigate the predicting factors of poor prognosis. Methods:98 patients with septicemia proven clinically and bacteriologically treated in our hospital from July 1997 to June 2004 were studied retrospectively.Results:Of all the septicemia episodes,about 82.7%(81 cases) of the septicemia patients were community-acquired and 17.3% were hospital-acquired. Gram-positive organisms accounted for 34.3 % of isolations,while gram-negative for 60.8 % and fungus for 4.9%. The commonest pathogens in community-acquired septicemia were Escherichia coli, followed by Staphy lococcus aureus and Klebsiella pneumoniae.Escherichia coli, fungus and acinetobacter spp were the leading pathogens causing hospital-septicemia.The susceptibility tests in vitro showed that the resistance of methicillin and vancomycin in 23 strains of 5. aureus was 39.1 % and 0% respectively,while the resistance rate of Escherichia coli against ampicillim,amikacin and levofloxacin was 90.3%,60.3%and 45.2% respectively.However,the resistance rates for the third-and fourth-generation cephalosporins and broad-spectrum penicillin were lower.No strain of Escherichia coli resistant to carbapenems was found. The mortality rate associated with septicemia was related with the hospital onset of infection,decrease of platelet,elevation of blood glucose and septic shock. Conclusion:The incidence of septicemia caused by fungus and acinetobacter spp is tending to elevate.Imipenem-cilastin sodium could be first chosen for Escherichia coli isolated from hospital-acquired septicemia and vancomycin for Staphylococcus aureus. In contrast,both imipenem-cilastin sodium and third-generation cephalosporins could be chosen for Escherichia coli isolated from community-acquired septicemia.