血液透析长期留置导管出口处病原菌分布及耐药性

Distribution of pathogens at exit of long-term indwelling catheter for hemodialysis and drug resistance

目的分析血液透析长期留置导管出口处常见病原菌分布及耐药特点,以便掌握其动态,制定相应防治措施。方法收集2009年1月-2011年6月医院血液透析患者长期留置导管出口处分泌物培养阳性者,进行病原菌分布及药敏结果分析。结果共分离出76株病原菌,革兰阳性菌70株占92.1%,主要为表皮葡萄球菌、棒杆菌属,占48.7%、31.6%,革兰阴性菌5株占6.6%,真菌1株占1.3%;37株表皮葡萄球菌中,28株为耐甲氧西林表皮葡萄球菌,检出率为75.7%;检出细菌对多种抗菌药物耐药。结论引起出口处感染的多为条件致病菌,感染患者多为免疫力低下人群;建立分泌物细菌监测机制,必要时开展主动筛查,对于早期发现和诊断多药耐药菌感染或定植,防止耐药菌株的传播有重要意义。

OBJECTIVE To analyze the characteristics of the distribution of common pathogens found at the exit of the long-term indwelling catheter for hemodialysis and their drug resistance,so as to identify their behavioral patterns and formulate corresponding prevention and treatment measures.METHODS The secretions tested positive from the exit of the long-term indwelling catheter for hemodialysis patients from Jan 2009 to Jun 2011 were collected,and distribution of the pathogenic bacteria and the result of drug susceptibility testing were analyzed.RESULTS A total of 76 strains of pathogens isolated,there were 70（92.1%） strains of gram-positive bacteria,mainly including Staphylococcus epidermidis（48.7%） and Corynebacterium（31.6%）,there were 5（6.6%） strains of gram-negative bacteria,and there was 1（1.3%） strain of gungi;of 37 strains of S.epidermidis,there were 28 strains of methicillin-resistant S.epidermidis with the detection rate of 75.7%;the isolated bacteria were resistant to many antibiotics.CONCLUSION The pathogens causing the exit infections are mostly the opportunistic pathogens,the patients infected with those pathogens are the major population with low immunity;to establish surveillance system for the bacteria for secretions and conduct active screening if it is necessary has great significance in early detection and diagnosis of multidrug-resistant bacteria infections and colonization and in the prevention of the spread of drug resistant strains.