摘要
目的:分析血液透析患者发生血管内导管相关性血流感染(catheter related blood stream infection,CRBSI)病原菌的流行病学特征及耐药情况。方法:收集732例尿毒症患者血液透析的临床资料,并对发生CRBSI的63例患者病原菌的流行病学特征及病原菌的耐药性进行评估分析。结果:732例血液透析患者送血及污染物品的培养样品中分离出病原菌63株,其中,革兰阴性菌34株(53.97%),革兰阳性菌28株(44.44%)。病原菌构成比列前五位的分别是表皮葡萄球菌10株(15.87%)、肺炎克雷伯菌10株(15.87%)、金黄色葡萄球菌9株(14.29%)、大肠埃希菌9株(14.29%)和铜绿假单胞菌8株(12.70%)。革兰阴性菌中,鲍曼不动杆菌耐药率较高,除头孢哌酮/舒巴坦和亚胺培南外,对其它抗菌药物耐药率均>80.00%;铜绿假单胞菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南耐药率<25.00%;肺炎克雷伯菌、大肠埃希菌对头孢哌酮/舒巴坦和亚胺培南耐药率<11.11%。革兰阳性菌中,溶血性葡萄球菌、金黄色葡萄球菌、表皮葡萄球菌对青霉素、头孢哌酮/舒巴坦、阿米卡星的耐药率>66.66%,对利福平的耐药率<30.00%,对万古霉素、利奈唑胺和替加环素对全部敏感。对血液透析患者发生CRBSI的单因素分析发现,血液透析患者年龄、导管留置时间与模式、白细胞水平、APACHEⅡ(分)、是否合并糖尿病与CRBSI发生率关系密切,其相对应因素比较,差异有统计学意义(P<0.05)。结论:了解血液透析患者发生CRBSI病原菌的流行病学特征及病原菌的耐药情况,有助于指导抗生素在治疗CRBSI中的合理应用。
Objective:Analysis of the epidemiological characteristics and drug resistance of catheter related blood stream infection (CRBSI) pathogenic bacteria in hemodialysis patients. Methods:The clinical data of hemodialysis of 732 patients with uremia were collected,and the epidemiological characteristics of pathogenic bacteria and the drug resistance of pathogenic bacteria of 63 patients with CRBSI were evaluated and analyzed. Results:63 strains of pathogenic bacteria were isolated from 732 hemodialysis patients'blood samples and contaminants.Among them,34 strains (53.97%) were Gram-negative bacteria and 28 strains (44.44%) were Gram-positive bacteria.Pathogen form than a list of the top five were 10 strains by staphylococcus epidermidis (15.87%),10 strains of klebsiella pneumoniae (15.87%),staphylococcus aureus,9 strains (14.29%),e.coli,9 strains (14.29%) and 8 strains pseudomonas aeruginosa (12.70%).In gram negative bacteria ,acinetobacter baumannii resistant rate generally higher,in addition to cefoperazone/shu ba and imide culture south,other antimicrobial susceptibility test in vitro resistance to common>80.00%.Pseudomonas aeruginosa was sensitive to piperacillin/azobactam,cefoperazone/sulbactam and imipenem,with drug resistance rate <25.00%.Klebsiella pneumoniae and escherichia coli were sensitive to cefoperazone/sulbactam and imipenem,with drug resistance rate<11.11%.Vancomycin,linezolid and tigacycline are all sensitive to the hemolytic staphylococcus,staphylococcus aureus and staphylococcus epidermidis in the three main gram- positive bacteria.The antimicrobial resistance rates of penicillin,cefoperazone/sulbactam and amikacin against three major gram-positive bacteria,>66.66%,and rifampicin<30.00%.In hemodialysis patients with single factor analysis of CRBSI found that hemodialysis patients age,catheter indwelling time and pattern, the WBC level,the APACHE Ⅱ(points),is closely associated with the incidence of CRBSI with diabetes mellitus and its corresponding factor comparison difference was statistically significant ( P <0.05). Conclusion:Understanding the epidemiological characteristics of pathogenic bacteria of CRBSI in hemodialysis patients and the drug resistance of pathogenic bacteria can help guide the rational application of antibiotics in the treatment of CRBSI.
作者
朱其荣
陈星
喻雪琴
陈芳
戢敏
李芸
敬雪明
ZHU Qi-rong;CHEN Xing;YU Xue-qin;CHEN Fang;JI Min;LI Yun;JING Xue-ming(Affiliated Hospital of North Sichuan Medical College,Nanchong 637000;West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China)
出处
《川北医学院学报》
CAS
2019年第2期201-204,共4页
Journal of North Sichuan Medical College
基金
四川省教育厅自然科学科研计划项目(17ZB0174)
关键词
血液透析
导管相关性血流感染
病原菌
流行病学特征
耐药性
Hemodialysis
Catheter-related bloodstream infections
Pathogenic bacteria
Epidemiological characteristics
Drug resistance
