脓毒症患者病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in sepsis patients

目的:探讨脓毒症患者病原菌的分布及其耐药情况,为临床合理选用抗菌药物提供指导。方法:回顾性分析277例脓毒症患者的细菌培养和药物敏感性试验结果。结果:277例细菌培养阳性脓毒症患者中,共分离出病原菌349株,其中革兰阴性菌190株,占54.44%,主要致病菌为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、鲍曼不动杆菌、粘质沙雷菌。革兰阳性菌占32.95%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌居前2位;念珠菌44株,占12.61%。革兰阴性杆菌单产超广谱-内酰胺酶(ESBLs)、单产头孢菌素酶(Amp C)、同产ESBLs+高产Amp C酶检出率分别为19.47%、5.79%、15.26%。革兰阳性分离株除对万古霉素、替考拉宁、喹奴普汀-达福普汀、利福平的耐药率较低外,其余抗生素的耐药率均>50.0%。革兰阴性分离株对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率较低,产酶株较非产酶株具有较高的耐药率。分离革兰阳性与革兰阴性菌株的耐药情况比较严重,特别是铜绿假单胞菌及肠球菌,对多种抗菌药物的耐药率均>50%。念珠菌分离株对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑及伏立康唑的耐药率分别为18.18%,22.72%,52.27%,38.64%和11.36%。结论:脓毒症患者革兰阳性与革兰阴性细菌耐药情况比较严重,念珠菌分离株对氟康唑、伊曲康唑的耐药率较高,建议临床抗感染治疗时,根据实验室药物敏感性试验结果合理选用抗菌药物。

Objective：To investigate distributions and drug resistance of pathogenic cultures isolated from inpatients with sepsis.Methods：Results of bacterial culture and drug sensitivity tests of 277 specimens from sepsis patients were analyzed retrospectively.Results：The 349 cultures which isolated from 277 inpatients with sepsis,there were 190 Gram negative-cultures（54.4%）,primary pathogenic bacteria of that were Pseudomonas aeruginosa,E.coli,K.pneumoniae,Enterobacter cloacae,Acinetobacter baumannii and Serratia marcescens,at the same time,there were 115 Gram positive cultures（32.95%）,ahead of them were coagulase-negative Staphylococcus（CNS）,Staphylococcus aureus and 44 strains of Candida were isolated.The detectable rate of ESBLs,Amp C and high yield Amp C amalgamated ESBLs occupied were 19.47 %,5.79% and 15.26% in Gram negative cultures.Otherwise,the resistance rate of antibiotics were all higher than 50.0% except VAN,TEC,QDA and Rifampin in Gram positive cultures.The rate of resistance to IPM,MEM,CSL were lower in Gram negative cultures,and the enzyme-procreant G-were much more drug resistance rate than that without enzyme.the Gram positive and Gram negative strains were highly resistant to antibacterial agents,respectively for Peudsomonas aeruginosa and Enterococcus,the resistances to most antibiotics were above 50%.the drug resistance rate of Candida to 5-Fluorocytosine,Amphotericin B,Fluconazole,Itraconazole,Voriconazole were 18.18%,22.72%,52.27%,38.64% and 11.36%.Conclusion：High drug resistance is common for Gram positive and Gram negative cultures from sepsis patients.The drug resistant rate of Candida were better high to Fluconazole and Itraconazole,so recommendations of clinical anti-infective treatment must be based on the antibiotic susceptively result of the clinical laboratory.