菌血症患者病原菌耐药情况和临床特征分析

Drug resistance of pathogens in patients with bacteremia and clinical features analysis

目的了解佛山市中医院菌血症患者的临床特征和病原菌耐药情况,探讨菌血症的相关因素,为临床预防、治疗菌血症、合理使用抗菌药物提供科学依据。方法对佛山市中医院2010年7月至2011年7月菌血症患者的临床资料进行回顾性分析,以Excel及SPSS统计分析病原菌种类和药物敏感情况。结果收集1 231例血培养标本,共分离病原菌174株,革兰阴性(G-)杆菌105株(60.34%),革兰阳性(G+)球菌59株(33.91%),真菌10株(5.75%);G-杆菌以大肠埃希菌和肺炎克雷伯菌为主,对亚胺培南和阿米卡星高度敏感,对氨苄西林高度耐药;G+球菌以溶血葡萄球菌和金黄色葡萄球菌为主,对万古霉素、替考拉宁、利奈唑胺、呋喃妥因、喹奴普汀-达福普汀、米诺环素全敏感,对青霉素高度耐药。医院获得性感染率39.0%,社区获得性感染率61.0%;有基础疾病者81.8%;科室主要分布于肿瘤科、重症监护病房。经过抗生素治疗,治愈及好转占87.0%、死亡占7.8%、未愈占5.2%。住院期间进行过手术或侵入性操作、插管占45.5%;临床上97.4%有发热,常伴寒战症状。结论应根据药敏分析结果选用最佳抗生素治疗菌血症患者,缩短治疗时间,减少细菌耐药性发生,提高菌血症的救治成功率;菌血症患者多伴有基础疾病,临床常见发热、寒战等症状。减少手术、侵入性操作、插管,合理使用广谱抗菌药物可以减少医院菌血症的发生率。

Objective To understand the clinical features of the patients with bacteremia in our hospital and the drug resistance status,to study the bacteremia-related factors to provide the scientific basis for prevent and treat- ment of bacteremia,and rational use of antibiotics. Methods The clinical data in the patients with bacteremia in our hospital from July 2010 to July 2011 were peformed the retrospective analysis on the kinds of pathogenic baceria and the drug sensitivity by Excel and SPSS softwares. Results 174 strains of pathogenic bacteria were cultured from 1 231 blood samples,including Gram-negative bacilli 105 strains（60.34 %）, Gram-positive cocci 59 strains（33.91 %） and fungi 105 strains （5.75%）. Gram-negative bacilli were mainly Escherichia coli and Klebsiella pneumoniae, and highly sensitive to imipenem and amikacin,but highly resistant to ampicillin. Gram-positive cocci were dominated by Staphylococcus haemolyticus and Staphylococcus aureus, and sensitive to vancomycin, teicoplanin, linezolid, nitro- furantoin, quinupristin, dalfopristin and minocycline,but highly resistant to penicillin. Hospital acquired infection ac- counted for 39.0 %and community acquired infections accounted for 61.0%）. The patients with underlying diseases accounted for 81.8%. The departments were mainly distributed in the oncology department and ICU. After treat- ment,cure and improvement accounted for 87. 0%, death accounted for 7. 8% and uncure accounted for 5. 2%. 45.5% of patients used surgery,aggressive procedure and intubation. 97.4% of patients had fever usually accompa- nied by chills in clinic. Conclusion Optimal antibiotics should be selected to treat bacteremia according to the results of the drug sensitivity tests,cut down the treatment time,reduce the probability of bacterial drug resistance and im- prove treatment success rate of bacteremia. Most patients with bacteremia have underlying diseases,fever and chills in clinic. Reducing operation, aggressive procedures,intubation and reasonable use of antibiotics can reduce the incidence of hospital-acquired bacteremia.