中心静脉导管定植病原体及药敏分析

Pathogen spectrum and drug sensitivity of central venous catheter colonization

目的:了解中心静脉导管定植病原体及药敏情况。方法:对疑似中心静脉导管感染的成年病人进行回顾性研究。采集病人临床资料、置管时间、部位和目的,导管培养结果及药敏情况。结果:651例病人纳入本研究,中位年龄为63(18～97)岁,累计置管762例次,中位置管时间为11(2～122)d。中心静脉导管病原体定植率为16.0%(122/762),共培养出134株病原体。肠外营养病人导管病原体定植率明显高于非肠外营养病人(18.8%比13.1%,χ2=4.662,P=0.032)。在导管定植病原体中,革兰阳性球菌占70株(52.2%),以溶血性葡萄球菌最常见;革兰阴性杆菌45株(33.6%),真菌19株(14.2%)。革兰阳性球菌主要对万古霉素和替考拉宁敏感,革兰阴性杆菌主要对β-内酰胺类抗生素联合β-内酰胺酶抑制剂及碳青霉烯类抗生素敏感。结论:革兰阳性球菌是最常见的中心静脉导管定植菌,对万古霉素和替考拉宁敏感。全肠外营养病人更易发生中心静脉导管病原体定植。

Objective To investigate the pathogen spectrum and drug sensitivity of central venous catheters （CVC） colonization. Methods A retrospective study was performed on patients with suspected catheter-related blood stream infection. Clinical information including age, gender, parenteral nutrition（PN）, duration of catheter placement, position and purpose of catheterization, cathether culture and drug sensitivity results was gotten. Results Six hundred and fifty-one patients were enrolled in the study and the median age was 63（18-97） years. In these patients, 762 CVC were placed and the median duration of catheter placement was 11（2-122） days. The prevalence of catheter colonization was 16.0% （122/762） and 134 germs were cultured in all. The prevalence of colonization was obviously higher in patients with PN than those without PN （18.8% vs 13.1%, X2=4.662,P=0.032）. Seventy gram-positive cocci （52.2%, 70/134） were cultured in the colonization of CVC, most of which were hemolytic staphylococci. Moreover, 45 gram-negatlve bacteria bacillus and 19 fungi were cultured. Gram-positive cocci were mainly sensitive to vancomycin and teicoplanin. Gram-negative bacteria bacillus were sensitive to β-1aetam/β-1actanase combination and carbapenems. Conclusions Gram-positive coccus is the most common colonized bacteria, which is sensitive to vancomyein and teicoplanin. The rate of colonization is obviously higher in patients with catheter used for total parental nutrition.