获得性免疫缺陷综合征患者社区获得性革兰阴性杆菌血流感染的临床特征

目的探讨获得性免疫缺陷综合征(AIDS)患者社区获得性革兰阴性杆菌(G^-杆菌)血流感染(BSI)的临床病原菌特征。方法回顾性分析2014年6月-2018年6月因社区获得性BSI住院治疗的AIDS患者112例,分析其临床特征、病原菌分离鉴定及药物敏感性试验情况。结果该研究共纳入112例患者,平均年龄(41.7±12.1)岁。患者BIS发生后,早期(12h内)应用敏感抗菌药物组患者好转率为85.71%,晚期(超过12h)使用敏感抗菌药物者好转率为59.52%,差异有统计学意义(P<0.01)。CD4^+T细胞数量越低,晚期使用敏感抗菌药物好转率越低,差异有统计学意义(P><0.05),本研究中共分离到116株G^-杆菌,其中排前5位的分别是:大肠埃希菌54株(46.55%)、肺炎克雷伯菌23株(19.83%)、阴沟肠杆菌9株(7.76%)、气单胞菌6株(5.17%)、非伤寒沙门菌5株(4.32%)。敏感性较高的抗菌药物分别是多粘菌素100%,美罗培南97.41%,亚胺培南97.39%,头抱同/舒巴坦92.86%,旅拉西拉/他唑巴坦91.38%,氯霉素90.90%,阿米卡星90.62%,莫西沙星90.20%。结论AIDS患者发生社区获得性BSI,应尽早应用敏感性高的抗菌药物,其中美罗培南、亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦等可作为首选经验用药。

Clinical features of community-acquired bloodstream infection due to Gram-negative bacilli in pafients with Acquired immune deficiency Syndrome

Objective To investigate the features of pathogenic bacteria for conimunity-acquired bloodstream infection due to Gram-negative bacilli in patients with AIDS and optimal therapeutic strategy.Methods A retrospective analysis was performed for the clinical data of patients with AIDS who were admitted to People's Hospital of Ba'nan District clue to community-acquired bloodstream infection from June 2014 to June 2018,and a statistical analysis was performed for their clinical features,pathogenic-bacteria,and results of drug sensitivity test.Results A total of 112 parents with AIDS were enrolled,with a mean age of(41.7±12.1)years.The patients who used sensitive antibiotics within 12 hours after the onset of community-acquired bloodstream infection achieved a significantly higher improvemenl rate than those who used such drugs at more than 12 hours after onset(85.71%vs.59.52%,P<0.01).The improvemenl rate achieved by the application of sensitive antibiotics at more than 12 hours after onset decreased with the lower in the CD4+T cell counts(P<0.05).A total of 116 strains of Gram-negative bacilli were isolated,among which the seven most common ones were 54 strains of Escherichia coli(46.55%),23 strains of Klebsiella pneumoniae(19.83%),9 strains of Enterobacter cloacae(7.76%),6 strains of Aeromonas(5.17%),5 nontyphoidal Salmonella(4.32%).These Grain-negative bacilli had the highest sensitivity to Polymyxin(100%),followed by Meropenem(97.39%),Cefoperazone/Schubatam(92.86%),Piperacillin/tazobactam(91.38%),Chloramphenicol(90.90%),amikacin(90.62%),Mosisasin(90.20%).Conclusion Once community-acquired bloodstream infection Occurs in patients with AIDS,highly sensitive antibiotics should be used as early as possible.Meropeneni,iniipenem,Cefoperazone/sulbactam and piperacillin/tazobactam can be used as firstline empirical antibiotics.