心脏手术患者医院内感染致病菌分布与耐药性分析

Distribution and antibiotics resistance related to nosocomial pathogenic bacteria infection in patients after cardiac surgery

目的调查心脏手术患者医院内感染的致病菌分布及其耐药性。方法分析2007年1月至2012年12月北京安贞医院心脏手术后发生医院内感染患者各种标本所分离的致病菌株，采用VITEK—Jr全自动细菌鉴定及药敏分析系统鉴定细菌类别，纸片扩散（K—B）法进行药敏试验，应用WHONET5．4软件进行数据分析。结果共分离致病菌697株，其中革兰阴性杆菌395株（56．7％），革兰阳性球菌239株（34．3％），真菌63株（9．0％）；呼吸道感染421例（60．4％），血液感染185例（26．5％），其他部位感染91例（13．1％）；主要致病菌中革兰阴性菌为不动杆菌124株（17．8％）、铜绿假单胞菌85株（12．2％）、肺炎克雷伯菌50株（7．2％），革兰阳性球菌为表皮葡萄球菌75株（10．8％）和金黄色葡萄球菌39株（5．6％），真菌为白色假丝酵母43株（6．2％）；不动杆菌呈现多重耐药，而铜绿假单胞菌耐药性有降低趋势，其他革兰阴性杆菌耐药性无明显变化；碳青霉烯类抗生素、头孢哌酮阍；巴坦及氧哌嗪青霉素／他唑巴坦对非发酵革兰阴性杆菌保持相对较高的抗菌活性。耐甲氧西林的金黄色葡萄球菌和凝固酶阴性葡萄球菌分别为82．9％和95．9％，未发现耐万古霉素的葡萄球菌。结论非发酵革兰阴性杆菌及葡萄球菌属是北京安贞医院心脏手术后患者医院内感染的重要病原菌，且耐药性突出。

Objective To investigate the clinical distribution and antibiotics resistance of nosocomial infection caused pathogenic bacteria in patients after cardiac surgery. Methods Clinical data from 612 patients after cardiac surgery under microbiologically documented nosocomial infection was retrospectively analyzed from January 2007 to December 2012. Identification on related bacterial was performed in an automatic ATB Expression system while antimicrobial susceptibility was tested by Kirby-Bauer method. Results were analyzed by WHONETS.4. Results There were 697 strains of clinical pathogenic bacilli isolates identified and 421 （60.4%） of them were isolated from sputum while 185 （26.5%） were from blood. Acinetobacter spp. （ 124 strains, 17.8% ）, Pseudomonas aeruginosa （85 strains, 12.2% ） and Klebsiella pneumoniae （50 strains, 7.2% ） were the predominant Gramnegative bacilli while S. epidermidis （75 strains, 10.8%） was the predominant Gram-positive cocci. The predominant eumycete was Candida albicans （43 strains, 6.2% ）. Results from the susceptibility test showed that carbopenems, cefoperazone/sulbactam and piperacillin/tazobactam were the most active antibiotics. The detection of meticillin-resistant Staphylococcus （MRS） were 82.9% in S aureus and 95.9% in coagulase negative Staphylococcus. There was no Staphylococcus strains resistant to vancomycin found. Conclusion Non-fermenting Gramnegative bacilli and Staphylococcus appeared the important pathogens in patients after cardiac surgery. Drug resistance to antibiotics was quite common. Prevention on nosocomial infection and rational use of antibiotics remained very important in reducing the amount of drug resistant strains.