医院获得性血流感染395例临床分析

目的 了解医院获得性血流感染的临床特点、病原菌分布及其耐药性.方法 参照卫生部医院感染诊断标准.对复旦大学附属华山医院 1995年1月至2004年12月所有血培养阳性的患者病史进行回顾性调查分析.按常规方法进行细菌分离、鉴定,细菌药物敏感试验采用Kirby-Bauer纸片扩散法,WH()NET 5.0进行分析.结果 华山医院1995到2004年十年间病史资料完整的医院获得性血流感染患者共395例.共分离获435株病原菌,其中革兰阳性菌占47.4%、革兰阴性菌占45.1%、真菌占7.6%.最常见的病原菌依次为凝固酶阴性葡萄球菌(21.4%)、金黄色葡萄球菌(17.9%)、大肠埃希菌(13.6%)、肺炎克雷伯菌(10.8%)、念珠菌属(7.4%)、肠球菌属(6.0%)、假单胞菌属(6.0%)及不动杆菌属(3.7%).金黄色葡萄球菌及凝固酶阴性葡萄球菌中甲氧西林耐药菌株分别占62.8%和87.1%.大肠埃希菌和克雷伯菌属对头孢噻肟和头孢他啶的敏感度为46.0%～78.0%和27.7%～40.4%.结论 医院获得性血流感染病原菌中革兰阳性菌检出率略高于革兰阴性菌.对常用抗菌药物耐药程度高.念珠菌属在血流感染中占有重要地位.

Three hundred and ninety-five eases of nosocomial bloodstream infection

Objective To characterize clinical feature, frequency of isolation and antimicrobial susceptibility of pathogens isolated from patients with nosocomial bloodstream infections in Huashan Hospital, Fudan University from 1995 to 2004. Methods The clinical data of all patients who were diagnosed with nosocomial bloodstream infections based on national diagnostic criteria of nosocomial bloodstream infections were retrospectively analyzed. The pathogens were routinely isolated and identified. Susceptibilities against antimicrobial agents were determined by Kirby-Bauer methods and analyzed by WHONET 5.0 software. Results During the 10-year study period, a total of 395 patients were diagnosed with nosocomid bloodstream infection with 435 strains isolated from blood specimen.Gram positive bacteria, Gram negative bacilli and fungi, accounted for 47.4%, 45.1 % and 7.6%,respectively. Coagulase-negative Staphylococci (21.4%), S. aures (17.9%), E.coli (13.6%), K. pneumoniae (10.8%), Candidaspp (7.4%), Enterococci (6.0%), Pseudomonasspp (6.0%) and Acinetobacter spp (3.7%) were frequently identified isolates. S. aures and coagulase-negative Staphylococci resistant to methicillin were 62.8% and 87.1%, respectively. The susceptibilities of cefotaxime and ceftazidime against E. coli and K. preumonine were 46%-78% and 27.7%-40.4%, respectively. Conclusions The Gram positive cocci are slightly more prevalent than Gram negative bacilli in nosocomial bloodstream infections and resistance to the first line antibiotics is common among all pathogens isolated. Candida spp is the fifth leading cause of nosocomial bloodstream infections.