静脉留置部位导管相关菌血症的病原学研究

Study on the pathogens of venous catheter-reloted blood stream infection

目的调查静脉留置导管相关性血流感染病原学特点。方法回顾性调查杭州医学院附属第一医院2003年1月至2005年9月静脉留置治疗患者感染的发生情况,并对其病原菌及耐药特点进行分析。结果165例患者共送检留置导管标本184份,140份标本检有病原菌,检出率为76.1%（140/184）。在165例患者中有150例进行了血液培养,发生血流感染的有103例,感染率为68.7%（103/150）。从140份静脉留置导管标本中共分离出171株病原菌,主要为表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌等。有44例患者静脉留置导管和血液培养出同一种病原菌,主要为表皮葡萄球菌。导管留置后到第一次血液培养出现阳性的时间大约为4~8d。同时从静脉留置导管和血液分离的21株表皮葡萄球菌全部对呋喃妥因和万古霉素敏感,除对利福平的耐药率较低外,对其它抗生素的耐药率都超过50%。结论静脉留置导管较易引起血流感染,引起血流感染病原菌主要以表皮葡萄菌为主,且耐药性严重。

Objective To study pathogens of venous catheter-related blood stream infections. Methods We examined records with catheter-related blood stream infections from Jan. 2003 to Sep. 2005. And the pathogens and bacterial resistance research was also included. Results 184 specimens were obtained from 165 blood stream infections episodes, of all the episodes,positive results of catheter culture were 140,the isolating rate was 76.1% （ 140/184）, 150 patients from 165 blood stream infections-episedes were examined by blood culture. The positive results were 103. The infection rate was 68.7% （103/150）. 171 strains of bacteria were isolated from 140 blood stream infection-episedes. The commonest pathogens were Staphylococcus epidermidis, Staphylococci aurelus, Pseudomonas aereginosa, Eschericha coli. 44 patient-specimens were isolated a same culture results both in catheter and blood. Staphylococcus epidermidis was the commonest pathogens. The first positive results of blood culture were abtained after about 4 - 8 days since venous terization. 21 strains of Staphylococcus epidermidis isolated from both blood and catheter culture were sensitive to furadantin and vancomycin. Its resistance rates against most of the antimicrobial agents was above 50% except for rifampicine. Conclusion Venous terization was easy to cause blood stream infections and Staphylococcus epidermidis was the commonest pathogens and its resistance rates was very high.