结缔组织病患者医院感染病原菌分布及药敏分析

Distribution and drug susceptibility of pathogenic bacteria causing nosocomial infections in patients with connective tissue disease

目的探讨结缔组织病医院感染病原菌分布及药敏情况,为其临床治疗提供依据。方法选择2007年12月-2012年12月体液培养阳性的86例结缔组织病患者合并医院感染的临床资料,分析其病原菌鉴定其药敏试验结果。结果 86例结缔组织病合并医院感染患者体液标本中分离出病原菌86株,其中革兰阴性菌占58.1%,革兰阳性菌占29.1%,真菌占12.8%;检出较高的病原菌依次为大肠埃希菌23.3%、白色假丝酵母菌11.6%、鲍氏不动杆菌10.5%及铜绿假单胞菌10.5%;革兰阴性菌对青霉素、哌拉西林耐药率>50.0%,对亚胺培南、美罗培南、阿米卡星等耐药率<10.0%;革兰阳性菌对四环素、磺胺甲噁唑/甲氧苄啶及克林霉素的耐药率分别为92.0%、88.0%及72.0%,对替加环素、利奈唑胺、呋喃妥因等药物较为敏感,均未检出耐药菌株。结论结缔组织病合并医院感染的主要病原菌为革兰阴性菌,真菌中白色假丝酵母菌感染也较为严重,应予以重视;在选用抗菌药物治疗时,理想选择为加有β-内酰胺酶抑制剂的抗菌药物。

OBJECTIVE To investigate the distribution and drug susceptibility of pathogenic bacteria causing nosocomiaI infections in the patients with connective tissue disease so as to guide the clinical treatment. METHODS The clinical data were collected from 86 patients with connective tissue disease complicated with nosocomial infections whose body fluid were cultured positive from Dec 2007 to Dec 2012, then the identification of pathogens was carried out, and the drug susceptibility testing was performed. RESULTS A total of 86 strains of pathogens have been isolated from the body fluid samples obtained from 86 patients with connective tissue disease complicated with nosocomial infections, among which the gram-negative bacteria accounted for 58.1%, the gram-positive bacteria 29.1%, the fungi 12.8 % ; the Escherichia coli , Candida albicans , Acinetobacter baumannii , and Pseudomonas aeruginosa were the predominant species of pathogens isolated, accounting for 23.3%, 11.6%, 10.5%, and 10. 5%, respectively. The drug resistance rates of the gram-negative bacteria to penicillin and piperacillin were more than 50.0%, the drug resistance rates to imipenem, meropenem, and amikacin were less than 10.0%; the drug resistance rate of the gram-positive bacteria to tetracycline was 92.0%, sulfamethoxazole-trimethoprim 88.0%, clindamycin 72.0%, while the gram-positive bacteria were susceptible to tigecycline, linezolid, and nitrofurantoin, and no drug resistant strains have been detected. CONCLUSION The gram-negative bacteria are the main pathogens causing nosocomial infections in the patients with connective tissue disease, the incidence of C. albicans infections is relatively high, which should be attached great importance to; the antibiotics containing the β-lactamase inhibitor are preferred for the drug therapy.