34例甲型H1N1流感危重症合并感染患者的病原菌分布情况分析

Distribution of pathogenic bacteria in 34 critical influenza A(H1N1) patients complicating bacteria infection

目的探讨重症监护病房(ICU)中甲型H1N1流感危重症患者感染的病原菌分布及其耐药情况。方法对兰州大学第一医院ICU 2009年10月27日-2010年2月28日收治的34例甲型H1N1流感患者的院内感染病原菌及其耐药性进行回顾性分析。结果 34例甲型H1N1流感患者治愈24例,死亡10例。检出病原菌的患者共18例,感染率52.9%。感染部位主要为呼吸道,占64.7%,其次是血液和静脉导管,分别占13.2%、9.6%。18例患者共分离出136株病原菌,主要菌株依次为鲍曼不动杆菌(67.6%)、铜绿假单胞菌(9.6%)、耐甲氧西林金黄色葡萄球菌(6.7%)、大肠埃希菌(5.9%)、光滑假丝酵母菌(5.1%)。在检出的鲍曼不动杆菌菌株中,63.0%对除多黏菌素B之外的所有抗生素耐药,其余的均为多重耐药菌;对鲍曼不动杆菌耐药率最低的为米诺环素(48.5%),其次为头孢哌酮/舒巴坦59.3%。鲍曼不动杆菌株数与T细胞亚群CD4+/CD8+比值呈线性相关(r=0.973,P=0.027)。结论本组34例甲型H1N1流感危重症患者主要感染菌株为鲍曼不动杆菌,均为多重耐药或泛耐药菌株,且鲍曼不动杆菌出现株数与患者免疫功能显著相关。

Objective To investigate the distribution and the drug resistance of pathogenic bacteria in the patients with critical influenza A（H1N1） in the intensive care unit（ICU）.Methods Pathogenic bacteria which infected the patients with influenza A（H1N1） in ICU of the first Hospital of Lanzhou University during Oct.2009 to Feb.2010,and their drug resistance were retrospectively analyzed.The correlation of these pathogenic bacteria and immune function of patients were also analyzed.Results Of 34 patients with influenza A（H1N1）,24 cases were cured and 10 cases died of influenza A（H1N1）.Pathogenic bacteria were detected from 18 patients,the infection rate was 52.9%.Respiratory tract was the main infection site,accounting for 64.7%.Blood and venous catheters followed respectively,accounting for 13.2% and 9.6%.A total of 136 strains of pathogenic bacteria were identified,they were successively as Acinetobacter baumannii（67.6%）,Pseudomonas aeruginosa（9.6%）,methicillin-resistant Staphylococcus aureus（6.7%）,Escherichia coli（5.9%） and sleek Candida yeast（5.1%）.For drug resistance,63.0% Acinetobacter baumanniis were resistant to all antibiotics except polymyxin B,and the rest were multi-resistant bacteria.Only 48.5% Acinetobacter baumannii strains showed resistance to minocycline,and 59.3% Acinetobacter baumannii strains showed resistance to cefoperazone/sulbactam.A linear correlation existed between the number of Acinetobacter baumanniis strains and the CD4＋/CD8＋ ratio of T cell subsets（r=0.973,P=0.027）.Conclusions Strains of Acinetobacter baumannii,multi-drug-resistant strains or pan-drug-resistant strains,are the major pathogenic bacteria infecting the 34 patients with critical influenza A（H1N1）.The number of Acinetobaceter baumannii is significantly associated with the immune function of these patients.