某院2013-2015年肾移植科病原分布及耐药性分析

目的:了解肾移植科病原菌的分布特点及耐药情况,为肾移植科经验性抗感染治疗提供依据。方法:对某医院肾移植科2013-2015年住院患者中分离的862株病原菌进行回顾性分析,包括分离部位、各类常见细菌检出情况、耐药情况等。结果:革兰阴性菌检出541株(62.76%),其次革兰阳性菌198株(22.97%)及真菌120株(13.92%)。革兰阴性菌中,排名前三的分别是大肠埃希菌(56.38%),克雷伯菌属(15.34%),铜绿假单胞菌(7.39%)。革兰阳性菌中,排名前三的分别是金黄色葡萄球菌(23.74%),粪肠球菌(16.67%),屎肠球菌(14.65%)。真菌中检出率最高的是白假丝酵母菌(6.03%)。未发现耐万古霉素葡萄球菌。肠杆科细菌对碳青霉烯类仍保持较高的敏感性。结论:肾移植科患者的感染以革兰阴性菌为主,主要为肠杆菌科细菌,其次是肠球菌。肾移植科经验性抗感染治疗应主要针对上述病原菌并考虑覆盖耐药菌,及时根据药敏结果调整用药,必要时合理的联合用药。

Pathogenic distribution and drug resistance analysis in Kidney Transplantation Department of a hospital in 2013-2015

OBJECTIVE According to the characteristics of pathogenic distribution and drug resistance in kidney transplantation department of a hospital, to plan the appropriate regimen of empirical antibiotic therapy. METHODS Retrospect analysis, including bacterial separation part, distribution, detection rate and resistance, was performed among 862 isolates from the patients from kidney transplantation department in 2013-2015. RESULTS Gram-negative bacilli accounted for 62.76%, followed by Gram-positive coccus accounted for 22.97%, fungus accounted for 13.92%. The top three isolates among Gram-negative bacilli were Escherichia coli (56.38%), Klebsiella (15.34%), Pseudomonas aeruginosa (7.39%). Staphylococcus aureus (23.74%) ranked the first in the gram positive bacteria, followed by enterococcus faecalis (16.67%) and enterococcus faecium (14.65%). Candida albicans (6.03%) ranked the first pathogen. No vancomycin resistant Staphylococcus strains were found. The sensitivity of Enterobacteriaceae remained high to carbapenems. CONCLUSION In kidney transplantation department, Gram-negative bacteria remain predominant and enterobacteriaceae is the main pathogen isolated, followed by enterococcus. These pathogens should be considered first when applying an empirical anti-infective therapy. Remedy should be modulated timely according to antimicrobial susceptibility test results and, when necessary, reasonable combination therapy can be applied.