摘要
目的分析血流感染中多重耐药菌(multi-drug resistant organisms,MDRO)的抗菌药物耐药率及危险因素,旨在合理治疗。方法选取2017—2021年期间中国人民解放军联勤保障部队第九一〇医院发生金黄色葡萄球菌、肠球菌属、肠杆菌目(不包括沙门氏菌和志贺氏菌)、铜绿假单胞菌和不动杆菌属血流感染病例696例,收集其全血标本分离出的病源菌株共711株,分析各类多重耐药菌株的抗菌药物耐药率,并分析MDRO感染的危险因素。结果从13187例全血血培养标本中筛选出非重复病例696例,阳性率为5.3%,共检出711株血流感染致病菌,其中共检出350株MDRO,检出率为49.23%(350/711)。在血流感染的病原菌中以大肠埃希菌最多,共277株占38.96%(277/711),其中MDRO有201株占57.43%(201/350);其次为肺炎克雷伯菌和金黄色葡萄球菌,分别为155株占21.80%(155/711)、89株占12.52%(89/711),其中肺炎克雷伯菌MDRO有43株占12.29%(43/350)、金黄色葡萄球菌MDRO有38株10.86%(38/350)。3种病原菌2017—2021年期间的变化趋势不明显。药敏试验显示,大肠埃希菌与肺炎克雷伯菌对头孢类、氟喹诺酮类药物耐药严重,氨基糖苷类耐药率比较低,对头霉素类、碳青霉烯类药物几乎无耐药性。金黄色葡萄球菌对林可霉素类、大环内酯类药物耐药率较高,对恶唑烷酮、糖肽类、甘氨酰环素类无耐药性。350例为MDRO感染,361为非MDRO感染,单因素分析显示,患者年龄、性别、心脑血管病史、肾功能不全、肺部疾病、低蛋白血症、肝胆疾病、电解质紊乱与贫血在MDRO感染方面无统计学意义(P>0.05);糖尿、泌尿系感染、外科手术、烧伤等因素为MDRO影响因素(P<0.05)。经Logistics分析,糖尿、泌尿系感染、外科手术、烧伤等为MDRO感染的危险因素(P<0.05)。结论血流感染患者MDRO感染较为严重,临床应重视早期防控,且应严格遵守抗菌药分级使用原则,合理应用,积极有效控制MDRO产生。
Objective To analyze the antimicrobial resistance rate and risk factors of multi drug resistant organisms(MDRO)in bloodstream infection for rational treatment.Methods A total of 696 cases of bloodstream infections of Staphylococcus aureus,Enterococcus,Enterobacteriaceae(excluding Salmonella and Shigella),Pseudomonas aeruginosa and Acinetobacter in our hospital from 2017 to 2021 were selected,and 711 pathogenic strains were isolated from their whole blood samples.The antimicrobial resistance rates of various multi drug resistant strains were analyzed and the risk factors of MDRO infection were analyzed.Results 696 non repeated cases were screened out from 13187 whole blood culture specimens,with a positive rate of 5.3%,and a total of 711 blood influenza pathogens were detected,among them,350 strains of MDRO were detected with a detection rate of 49.23%(350/711).Among the pathogenic bacteria of bloodstream infection,Escherichia coli was the most,with 277 strains accounting for 38.96%(277/711),of which 201 strains were MDRO,accounting for 57.43%(201/350);followed by Klebsiella pneumoniae and Staphylococcus aureus,with 155 strains accounting for 21.80%(155/711)and 89strains accounting for 12.52%(89/711),among which 43 strains of Klebsiella pneumoniae MDRO accounted for 12.29%(43/350)and 38 strains of Staphylococcus aureus MDRO accounted for 10.86%(38/350).The change trend of the three pathogens during 2017-2021 was not obvious.The drug sensitivity test showed that Escherichia coli and Klebsiella pneumoniae were highly resistant to cephalosporins and fluoroquinolones,and the drug resistance rate of aminoglycosides was relatively low.They had almost no resistance to cephalosporins and carbapenems.Staphylococcus aureus has a high resistance rate to lincomycin and macrolides,but no resistance to oxazolidinone,glycopeptides and glycylcyclins.There were 350 cases of MDRO infection and 361 cases of non MDRO infection.Univariate analysis showed that the age,sex,cardiovascular and cerebrovascular history,renal insufficiency,lung disease,hypoalbuminemia,hepatobiliary disease,electrolyte disorder and anemia of the patients had no statistical significance in MDRO infection(P>0.05);diabetes,urinary tract infection,surgical operation and burn were the influencing factors of MDRO(P<0.05).According to logistic analysis,diabetes,urinary tract infection,surgical operation and burn were the risk factors of MDRO infection(P<0.05).Conclusion The infection of MDRO in patients with bloodstream infection is serious,and early prevention and control should be paid attention to,and the principle of graded use of antibiotics should be strictly observed,and the rational application should be carried out to actively and effectively control the production of MDRO.
作者
陈招虹
尤晓萍
蔡媛媛
翁镔
CHEN Zhao-hong;YOU Xiao-ping;CAI Yuan-yuan;WENG Bin(Department of Clinical Laboratory,91Oth Hospital of Joint Services Support Force of PLA,Quanzhou,Fujian 362000,China)
出处
《中国热带医学》
CAS
2023年第2期176-180,209,共6页
China Tropical Medicine
关键词
多重耐药菌
血流感染
菌株变迁
抗菌药物耐药率
危险因素
Multidrug resistant bacteria
bloodstream infection
strain change
antimicrobial resistance rate
risk factors
