中心静脉导管相关性血流感染的病原菌分布与耐药性分析

Distribution and drug-resistance of pathogens in patients with central venous catheter-related bloodstream infections in ICU

目的分析医院综合ICU患者中心静脉导管相关性血流感染(CRBSI)的病原菌分布及其耐药性,为CRBSI治疗提供合理依据。方法回顾性分析医院2010年6月-2013年6月2 344例置入中心静脉导管患者的临床资料,分析确诊患者血液及中心静脉导管末端细菌培养及药敏结果,数据采用SPSS 16.0统计软件进行分析。结果 218例确诊为CRBSI,感染率为9.3%;共分离培养出病原菌218株,其中革兰阳性菌占64.7%、革兰阴性杆菌占21.1%、真菌占14.2%,前3位病原菌依次为表皮葡萄球菌、金黄色葡萄球菌、肠球菌属及白色假丝酵母菌,分别占28.9%、14.2%、8.3%及8.3%;革兰阳性菌耐药严重,但对利奈唑胺、万古霉素和替考拉宁均敏感;革兰阴性菌对各种抗菌药物耐药率均很高,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和亚胺培南耐药性相对较低;白色假丝酵母菌和热带假丝酵母菌对氟康唑、伏立康唑敏感性良好,光滑假丝酵母菌对氟康唑耐药率较高,对伏立康唑较敏感。结论 CRBSI的主要病原菌为革兰阳性菌和革兰阴性菌,耐药现象严重,治疗困难,对病原菌进行培养和药物敏感性试验,对合理选用抗菌药物治疗CRBSI具有重要意义。

OBJECTIVE To determine the distribution and drug resistance characteristics of pathogens in patients with central venous catheter‐related bloodstream infections （CRBSI） and guide clinical doctors to select antibiotics correctly .METHODS A total of 2344 patients with indwelling catheters during Jun .2010 to Jun .2013 were included and retrospectively analyzed .The venous blood and catheter tip of the 218 patients were cultured with a quantitative method and their antibiotic susceptibility was detected . Data were analyzed with the statistical software SPSS 16 .0 .RESULTS A total of 218 patients were confirmed with CRBSI ,with infections rate of 9 .3% . Totally 218 strains of pathogens were isolated ,including gram‐positive bacteria （64 .7% ） ,gram‐negative bacilli （21 .1% ） and fungi （14 .2% ） .Pathogens ranking the first four were Staphylococcus epidermidis （28 .9% ） , Staphylococcus aureus （14 .2% ） , Enterococcus （8 .3% ） and Candida albicans （8 .3% ） .Gram‐positive bacteria were severely resistant ,but susceptible to linezolid ,vancomycin and teicoplanin .Gram‐negative bacteria had high resistance to various antibacterials , but less resistant to cefoperazone/sulbactam , piperacillin/tazobactam and imipenem .Candida albicans and C .tropicalis were susceptible to fluconazole and voriconazole .C .glabrata was resistant to fluconazole but susceptible to voriconazole .CONCLUSION Gram‐positive and gram‐negative bacteria are still the most important pathogens in CRBSI and have multiple drug‐resistances , which are difficult for treatment .Bacterial culture and antibiotic susceptibility tests are very important to select antibiotics correctly for treatment of CRBSI .