心脏术后中心静脉导管相关性感染的病原菌及药物敏感性分析

目的探讨心脏术后中心静脉导管相关性感染（CVC-RI）的致病菌群分布及药敏情况。方法对我院2009年1月至2011年6月间,进行心脏直视手术并行中心静脉置管术的526例患者临床病历进行筛查,对发生CVC-RI患者的临床资料及细菌培养、药物敏感性试验结果进行回顾性分析。结果 38例患者发生了CVC-RI,总发生率为7.22%（38/526）,培养出病原菌48株,其中革兰氏阳性菌有26株（54.16%）、革兰氏阴性菌有18株（37.50%）、真菌4株（8.33%）;常见的致病菌有金黄色葡萄球菌（29.16%）、表皮葡萄球菌（13.67%）、铜绿假单胞菌（12.50%）。药物敏感性分析显示,革兰氏阳性菌对万古霉素敏感性为100%,其次是氯霉素、左旋氧氟沙星和哌拉西林;而革兰氏阴性菌耐药率高,对亚胺培南敏感性较高,其次是左旋氧氟沙星、头孢他啶、哌拉西林/他唑巴坦。结论心脏术后发生CVC-RI病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌为多见,抗感染治疗应据细菌药物敏感结果合理选用抗生素。

Pathogenic bacteria and drug sensitivity in central venous catheter related infections after heart surgery

Objective To investigate the distribution of pathogenic bacteria group and drug sensitivity in central venous catheter related infections(CVC-RI) after heart surgery.Methods The clinical records of 526 patients were screened after open heart surgery and central vein catheterization from Jan.2009 to June 2011.The clinical materials of CVC-RI patients,and results of bacteria culture and drug sensitivity test were analyzed retrospectively.Results There were 38 patients suffered from CVC-IR and the total occurrence rate was 7.22%(38/526).There were 48 stains of pathogenic bacteria cultured,among which there were 26 strains of Gram-positive bacteria(54.16%),18 stains of Gram-negative bacteria(37.50%) and 4 stains of fungus(8.33%).Common pathogenic bacteria included Staphylococcus aureus(29.16%),Staphylococcus epidermidis(13.67%) and Pseudomonas aeruginosa(12.50%).The analysis on drug sensitivity showed that the sensitivity of Gram-positive bacteria to vancomycin was 100% and followed by chloromycetin,levofoxacin and piperacillin.The drug resistance of Gram-negative bacteria was high with a higher sensitivity to imipenem and followed by levofoxacin,ceftazidime and piperacillin/tazobactam.Conclusion The pathogenic bacteria inducing CVC-IR are commonly Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa after heart surgery,so antibiotics should be chosen reasonably according to drug sensitivity of pathogenic bacteria in anti-infection treatment.