摘要
目的了解经永久性中心静脉留置导管行血液透析的尿毒症患者导管感染的临床特征、病原菌分布和耐药性,指导临床合理选择抗菌药物。方法对2011年9月-2012年8月医院17例长期置管透析导管感染患者留取血液标本,进行细菌鉴定及药敏试验分析。结果 17例患者血培养阳性14例,阳性率为82.4%;主要病原菌依次为表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌,分别占35.7%、28.6%、14.3%、14.3%;革兰阴性菌中铜绿假单胞菌仅对阿米卡星、氯霉素、万古霉素敏感;鲍氏不动杆菌和阴沟肠杆菌对环丙沙星、头孢噻肟、阿米卡星、氯霉素、亚胺培南、头孢哌酮/舒巴坦敏感;革兰阳性菌对苯唑西林、头孢噻肟、万古霉素、阿米卡星、氯霉素敏感。结论长期置管透析患者出现导管相关性感染,以葡萄球菌属多见,大多对头孢噻肟、环丙沙星、阿米卡星、氯霉素、万古霉素/亚胺培南等敏感,少数患者感染铜绿假单胞菌等耐药菌株,应选用阿米卡星、氯霉素、万古霉素。
OBJECTIVE To investigate the clinical characteristics of catheter-related infections in uremia patients undergoing hemodialysis through permanent catheter indwelling and analyze the distribution and drug resistance of pathogens so as to guide the reasonable use of antibiotics. METHODS A total of 17 cases of patients with catheter- related infections, who underwent hemodialysis through permanent catheter indwelling from Sep 2011 to Aug 2012, were enrolled in the study, then the blood specimens were sampled, and the bacterial identification and drug susceptibility testing were performed. RESULTS Totally 14 of 17 cases were positive for blood culture with the positive rate of 82.4 % ; the Staphylococcus epidermidis （35.7%）, Staphylococcus aureus （28.6 % ）, Pseudomonas aeruginosa（14.3 %）, and Acinetobacter baumannii （14.3 %） were the predominant species of pathogens. Among the gram-negative bacteria, the P. aeruglnosa was only susceptible to amikacin, chloramphenicol, and vancomycin% the A. baumannii and Enterobacter cloacae were susceptible to ciprofioxacin, cefotaxime, amikacin, chloramphenicol and cefoperazone-sulbactam; the gram-positive bacteria were susceptible to oxacillin, cefotaxime, vancomycin, amikacin, and chloramphenicol. CONCLUSION The Staphylococci are the most common species of pathogens causing catheter-related infections in the patients undergoing hemodialysis through permanent catheter indwelling, most of which are susceptible to cefotaxime, ciprofioxacin, amikacin, chloramphenicol, and vancomycin-imipenem; small group of patients are infected with P. aeruginosa and should be treated with amikacin, chloramphenicol, and vancomycin.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第22期5548-5550,共3页
Chinese Journal of Nosocomiology
基金
潜江市科技局基金资助项目(201102P012)
关键词
血液透析
永久性中心静脉导管
细菌培养
药敏试验
Hemodialysis
Permanent central venous catheter
Bacterial culture
Drug susceptibility testing
