586例败血症病原菌分布及耐药性分析

Pathogen distribution and antibiotic resistance among 586 septicemia patients

目的了解常德市第一人民医院临床分离的败血症病原学分布及对常用抗生素的耐药情况,为临床提供诊断和治疗的依据。方法回顾性总结常德市第一人民医院2002年1月～2007年4月临床确诊的586例败血症病原菌分布特点及药敏结果。结果共检出病原菌613株,其中G+菌426株(69.5%),G-菌163株(26.6%),真菌24株(3.9%)。检出较多的为表皮葡萄球菌(24.5%)、金黄色葡萄球菌(23.2%)、大肠埃希菌(8.3%)、棒状杆菌(5.9%)和链球菌(5.7%)。儿科患者中G+菌感染比例为78.7%,高于成人败血症患者(55.7%)。药敏试验显示主要致病菌均存在多重耐药,G+致病菌对万古霉素耐药性最低,G-致病菌对碳青霉烯类抗生素耐药率最低,可将此2类抗生素作为败血症治疗的首选药物。结论近年来常德市第一人民医院败血症患者以G+菌感染为主,且呈现多重耐药倾向,值得进一步研究。临床应依据本地区药敏结果优化选择抗生素,并采用合理的手段降低耐药率的发生。

Objective To investigate the distribution and drug resistance among patients with septicemia to improve the clinical diagnosis and treatment. Methods Pathogen distribution and drug resistance among 586 patients from January 2002 to April 2007 were retrospectively studied. Results Totally 613 strains of bacteria were isolated, including 426 strains of Gram-positive bacteria （69.5%）, 163 strains of Gram-negative bacteria （26.6%） and 24 strains of fungi （3.9 % ）. The most common pathogens were Staphylococcus epidermidis （24.5 %）, Staphylococcus aureus （23.2 %）, Eseherichia eoli （8. 3%）, Corynebaeterium （5.9%）, and Streptococcus （5.7%）. In child patients, the infection ratio of Gram-positive bacteria was 78.7%, higher than in adults （55.7%）. Various resistances to all detected antibiotics were found among the bacteria isolated. Drug resistance test showed Vaneomyein was the most sensitive to Grampositive bacteria, and earbapenem most sensitive to Gram-negative bacteria. Conclusion Gram-positive bacteria remain the most common pathogens among patients with septicemia and multi-drug resistance was presented by these bacteria Proper antibiotics should be selected according to antibiotic sensitivity tests for improving the curing rates of infection.