心脏术后中心静脉导管相关性感染的病原菌及药物敏感性分析

Pathogenic bacteria and drug sensitivity in central venous catheter related infections after heart surgery

目的探讨心脏术后中心静脉导管相关性感染(CVC-RI)的致病菌群分布及药敏情况。方法对我院2009年1月至2011年6月间,进行心脏直视手术并行中心静脉置管术的526例患者临床病历进行筛查,对发生CVC-RI患者的临床资料及细菌培养、药物敏感性试验结果进行回顾性分析。结果 38例患者发生了CVC-RI,总发生率为7.22%(38/526),培养出病原菌48株,其中革兰氏阳性菌有26株(54.16%)、革兰氏阴性菌有18株(37.50%)、真菌4株(8.33%);常见的致病菌有金黄色葡萄球菌(29.16%)、表皮葡萄球菌(13.67%)、铜绿假单胞菌(12.50%)。药物敏感性分析显示,革兰氏阳性菌对万古霉素敏感性为100%,其次是氯霉素、左旋氧氟沙星和哌拉西林;而革兰氏阴性菌耐药率高,对亚胺培南敏感性较高,其次是左旋氧氟沙星、头孢他啶、哌拉西林/他唑巴坦。结论心脏术后发生CVC-RI病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌为多见,抗感染治疗应据细菌药物敏感结果合理选用抗生素。

Objective To investigate the distribution of pathogenic bacteria group and drug sensitivity in central venous catheter related infections（CVC-RI） after heart surgery.Methods The clinical records of 526 patients were screened after open heart surgery and central vein catheterization from Jan.2009 to June 2011.The clinical materials of CVC-RI patients,and results of bacteria culture and drug sensitivity test were analyzed retrospectively.Results There were 38 patients suffered from CVC-IR and the total occurrence rate was 7.22%（38/526）.There were 48 stains of pathogenic bacteria cultured,among which there were 26 strains of Gram-positive bacteria（54.16%）,18 stains of Gram-negative bacteria（37.50%） and 4 stains of fungus（8.33%）.Common pathogenic bacteria included Staphylococcus aureus（29.16%）,Staphylococcus epidermidis（13.67%） and Pseudomonas aeruginosa（12.50%）.The analysis on drug sensitivity showed that the sensitivity of Gram-positive bacteria to vancomycin was 100% and followed by chloromycetin,levofoxacin and piperacillin.The drug resistance of Gram-negative bacteria was high with a higher sensitivity to imipenem and followed by levofoxacin,ceftazidime and piperacillin/tazobactam.Conclusion The pathogenic bacteria inducing CVC-IR are commonly Staphylococcus aureus,Staphylococcus epidermidis and Pseudomonas aeruginosa after heart surgery,so antibiotics should be chosen reasonably according to drug sensitivity of pathogenic bacteria in anti-infection treatment.