静脉导管尖端培养的病原菌分析

Pathogens cultured from venous catheters tips

目的调查与分析静脉导管尖端培养的病原菌分布及耐药性,为抗菌药物的合理应用提供参考依据。方法回顾性分析2008年11月-2013年5月356份导管尖端送检标本进行培养分析,采用滚碟法培养,药敏试验用K-B法进行,采用WHONET 5.4软件分析药敏结果。结果 356份样本中有113份培养阳性,检出革兰阴性杆菌75株占66.37%,革兰阳性球菌35株占30.98%,真菌3株占2.65%;前5位的病原菌分别为凝固酶阴性葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌及金黄色葡萄球菌,分别占17.70%、15.05%、12.39%、10.62%、8.85%及8.85%;凝固酶阴性葡萄球菌和金黄色葡萄球菌对万古霉素、氨苄西林/舒巴坦、左氧氟沙星、阿米卡星、呋喃妥因等较敏感;革兰阴性菌对亚胺培南、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、阿米卡星、左氧氟沙星的敏感性较高;产ESBLs肺炎克雷伯菌检出率为70.59%,产ESBLs大肠埃希菌检出率占70.00%;产碳青霉烯酶鲍氏不动杆菌检出率为57.14%,产碳青霉烯酶铜绿假单胞菌检出率为41.67%。结论静脉导管尖端感染的病原菌以革兰阴性菌为主,而且耐药严重,监测和分析病原菌种类及其耐药性对指导临床合理用药具有重要意义。

OBJECTIVE To investigate the distribution and drug resistance of pathogens cultured from venous catheters tips so as to provide guidance for reasoanbel use of antibiotics .METHODS Totally 356 submitted specimens that were obtained from catheters tips from Nov 2008 to May 2013 were cultured by using roll‐late method ,the drug susceptibility testing was performed by using K‐B method ,and the results of the drug suscepti‐bility testing were analyzed with the use of WHONET 5 .4 software .RESULTS Of 356 specimens ,113 were cultured positive ,and 75 （66 .37% ） strains of gram‐negative bacilli ,35 （30 .98% ） strains of gram‐positive cocci , and 3 （2 .65% ） strains fungi were isolated ;the coagulase‐negative Staphylococcus ,Klebsiella pneumoniae ,Acin‐etobacter baumannii ,Pseudomonas aeruginosa ,Escherichia coli ,and Staphylococcus aureus ranked the top five species of pathogens ,accounting for 17 .70% ,15 .05% ,12 .39% ,10 .62% ,8 .85% ,and 8 .85% ,respectively . The coagulase‐negative Staphylococcus and S .aureus were susceptible to vancomycin ,ampicillin‐sulbactam ,levo‐floxacin ,amikacin ,and nitrofurantoin ;the gram‐negative bacteria were susceptible to imipenem ,cefoperazone‐sulbactam ,ampicillin‐sulbactam ,amikacin ,and levofloxacin .The isolation rate of the ESBLs‐producing K .pneu‐moniae was 70 .59% ,the ESBLs‐producing E .coli 70% ,the carbapenemase‐producing A .baumannii 57 .14% ,the carbapenemase‐producing P .aeruginosa 41 .67% .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing the venous catheters tips infections and are highly drug‐resistant;the surveillance of the species of patho‐gens and analysis of the drug resistance have great significance in the reasonable clinical use of antibiotics .