2型糖尿病合并血流感染的病原菌分布及耐药性研究

目的探讨2型糖尿病(T2DM)合并血流感染(BSI)的病原学特征,为早期合理用药提供依据。方法回顾性分析2015年1月-2018年12月铜陵市人民医院T2DM合并BSI患者的临床及细菌学血培养资料。结果共158例患者纳入研究。共分离出非重复病原菌160株,其中革兰阴性菌占71.9%(115/160),革兰阳性菌占26.2%(42/160),真菌占1.9%(3/160)。前6位检出菌依次为:大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、阴沟肠杆菌、凝固酶阴性葡萄球菌和β溶血链球菌。原发感染部位为泌尿道者最常见的致病菌为大肠埃希菌。社区获得性感染占55.7%(88/158),医院感染占44.3%(70/158);T2DM合并BSI患者90 d总病死率为15.8%(25/158)。多重耐药菌(MDRO)占30.6%(49/160);医院获得性血流感染(NBSI)患者中检出30株MDRO,科室分布以重症监护病房(ICU)最多。大肠埃希菌和肺炎克雷伯菌中产ESBL株分别占36.7%(18/49)和30.2%(13/43);未检出碳青霉烯类耐药大肠埃希菌;碳青霉烯类耐药肺炎克雷伯菌(CRKP)检出率达23.3%(10/43)。MRSA的检出率为33.3%(6/18),金黄色葡萄球菌对庆大霉素、左氧氟沙星敏感率超过70%;对利福平敏感率超过90%。未发现耐万古霉素和利奈唑胺葡萄球菌。结论 T2DM合并BSI患者病死率较高,病原菌以革兰阴性菌为主,大肠埃希菌是最常见的病原菌,NBSI中MDRO检出率高。应重视原发感染部位对T2DM合并BSI的影响。

Etiological distribution and antibiotic resistance profile of bloodstream infections in patients with type 2 diabetes mellitus

Objective To investigate the etiological features and antibiotic resistance profile of bloodstream infections (BSIs) in type 2 diabetes mellitus (T2DM) patients for early rational treatment.Methods Microbiological and clinical data were collected and reviewed retrospectively from the T2DM patients with confirmed BSIs who were treated as inpatients in Tongling People’s Hospital from January 2015 to December 2018.Results During the 4-year study period,a total of 160 nonduplicate pathogens were identified from 158 T2DM patients.Of the 160 pathogenic isolates,gram negative organisms,gram positive organisms,and fungal pathogen accounted for 71.9% (115/160),26.2% (42/160) and 1.9% (3/160),respectively.The top six pathogenic species were E.coli,K.pneumoniae,S.aureus,E.cloacae,coagulase-negative Staphylococcus,and beta-haemolytic Streptococcus.E.coli was the most frequently isolated BSI pathogen in T2DM patients secondary to urinary tract infection.Community-acquired BSIs and nosocomial BSIs accounted for 55.7% (88/158) and 44.3% (70/158),respectively.The overall 90-day mortality was 15.8% (25/158).About 30.6% (49/160) of the pathogens were multi-drug resistant,including 30 strains isolated from nosocomial BSIs,mainly in intensive care unit.About 36.7% (18/49) of the E.coli isolates and 30.2% (13/43) of the K.pneumoniae isolates produced extended-spectrum β-lactamases.No carbapenem-resistant strains were found in E.coli.About 23.3% (10/43) of the K.pneumoniae strains were carbapenem-resistant.The prevalence of MRSA was 33.3% (6/18) in S.aureus.More than 70% of the S.aureus strains were susceptible to gentamicin and levofloxacin.More than 90% of S.aureus strains were susceptible to rifampicin.No Staphylococcus strain was found resistant to vancomycin or linezolid.Conclusions T2DM complicated with BSI is associated with high mortality.Gram-negative bacilli,especially E.coli,are the major pathogens of BSIs in T2DM.Multi-drug resistant strains are more often isolated from nosocomial BSIs.We should pay more attention to the role of primary site of infection in the BSI of T2DM patients.