危重病者中心静脉导管性脓毒症病原学分析

目的了解危重病患者中心静脉导管相关性脓毒症(CRS)的临床特点、菌群分布及药敏情况.方法对2001～2003年发生的40例中心静脉导管相关性脓毒症患者进行回顾性调查分析.结果40例CRS中,共分离出74株细菌,其中革兰氏阴性杆菌20株,革兰氏阳性球菌42株,真菌12株.CRS最常见的病原是表皮葡萄球菌和金黄色葡萄球菌.革兰氏阴性杆菌最常见的是绿脓假单胞菌.大多数细菌均有较高程度的耐药性.革兰氏阳性球菌对万古霉素的敏感率达100%,革兰氏阴性杆菌对亚胺培南及阿米卡星的敏感率分别为80%和65%.结论CRS的有效处理方法是及时拔除感染的导管.万古霉索和(或)阿米卡星可作为治疗CRS的首选用药.

A Clinical and Etiologic Analysis on Central Venous Catheter-related Sepsis in Critical Patients

Objective To investigate the clinical characteristics, bacteria spectrum and drug-sensitivity in critical patients with central venous catheter-related sepsis (CRS). Methods A retrospective study was carried out among 40 critical patients with central venous catheter-related sepsis between Jan. 2001 and Feb.2003.Results 74 strains were isolated from these patients including 20 Gram-negative bacteria strains, 42 Gram-positive bacteria strains and 12 fungi strains. Staphylococcus epidermis and Staphylococcus aureus were the most frequent pathogens, and in Gram-negative bacteria, aeruginosus bacillus were the most frequent strains. The pathogens mostly had a relative higher drug-resistance. Gram-positive bacteria was sensitive to vancomycin with a 100% sensitivity, and Gram-negative bacteria was partial sensitive to imipenem with a 80% sensitivity and amikacin with a 65% sensitivity. Conclusions The effective treatment to patients with central venous catheter-related sepsis is prompt removal of infective catheters, and Vancomycin and amikacin may be the first chosen drugs.