心外科ICU血流感染患者血培养病原菌分布特点及耐药性分析

目的:了解心外科重症监护室(CDICU)血流感染患者的病原菌分布特点及其耐药性,指导临床合理使用抗菌药物。方法:回顾性分析2012-01-2013-05武汉市协和医院CDICU临床血培养病原菌分布特点和耐药性。结果:669例血培养阳性113例,血培养阳性率16.9%,共分离出115株病原菌,其中革兰阴性杆菌48株(占41.7%),革兰阳性球菌46株(占40.0%),真菌21株(占18.3%)。革兰阴性杆以鲍曼不动杆菌为主,对多种抗生素的耐药率均较高;革兰阳性球菌以表皮葡萄球菌、溶血葡萄球菌和人葡萄球菌为主,对替考拉丁和利奈唑胺耐药率均为米诺环素也未出现耐药株,人葡萄球菌、溶血葡萄球菌和施氏葡萄球菌对青霉素和红霉素的耐药率都是100%;真菌以热带假丝酵母菌为主。产超广谱β-内酰胺酶(ESBLs)大肠杆菌的发生率为100%。多重耐药鲍曼不动杆菌(MDRA)的发生率为95.2%。耐甲氧西林的金黄色葡萄球菌(MRSA)发生率为100%,耐甲氧西林凝固酶阴性的葡萄球菌(MRSCoN)为97.0%。屎肠球菌对高水平庆大霉素耐药(HLGR)的发生率为50.0%。结论:CDICU血流感染患者的病原菌谱中,革兰阴性菌与革兰阳性菌比例相近,其中革兰阴性菌稍占优势,均高于真菌的比例。多重耐药菌中MDRA、HLGR、MRSA、MRSCoN发生率较高。加强细菌耐药检测,为临床合理使用抗菌药物提供重要依据。

Distribution and drug resistance of pathogenic bacteria isolated from CDICU bloodstream infected patients

Objective： To investigate the distribution and drug resistance of pathogenic bacteria isolated from cardiosurgery intensive care unit （CDICU） bloodstream infected patients. Method： The clinical distribution and drug resistance of pathogens isolated from blood cultures of the patients in CDICU of Wuhan Union Hospital during January 2012 to May 2013 was analyzed retrospectively. Result：Blood culture was performed for a total of 669 cases and 113 cases were positive. The positive rate of blood culture was 16.9%. One hundred and fifteen strains of pathogens were isolated. The isolated pathogens included 48 （41.7%） strains of gram-negative bacteria, 46 （40.0%） of gramositive bacilli bacteria and 21 （18.3%） of fungi. Acinetobacter baumanii was the main gram- negative bacteria and had multidrug-resistance to the drugs tested. Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis were the main gramositive bacteria and had resistance to Telcoplanin and Linezolid with the drug resistance rates of 0, and had no resistance to Minocycline. The resistance rates of Staphylococcus hominis, Staphylococcus haemolyticus and Staphylococcus schleiferi were 100% to Penicillin and Erythromycin. Candida tropicalis was the major fungi. The incidences of Escherichia coli producing extended-spectrum β-Lactamases （ESBLs）, multidrug resistant Acinetobacter baumannii （MDRA）, methicillin-resistant Staph- ylococcus aureus （MRSA） and methicillin-resistant Staphylococcus coagulase negative （MRSCoN） were 100%, 95.2 %, 100 % and 97 %, respectively. The incidences of high level Gentamicin resistance （HLGR） of Enterohacteriaceae faecalis was 50.0 %. Conclusion：Separation rate of gram-negative bacilli was similar to gram-positive bacilli＇s in CDICU bloodstream infection, which were both higher than fungi＇s significantly. The drug-resistance rates of ESBLs, MDRA, HLGR, MRSA and MRSCoN were high. It should be paid attention to strengthen drug resistance detection, which can provide important evidence for clinicians to rationally use antibiotics.