儿科重症监护病房血管内导管相关性血流感染病原菌分布特点及耐药性分析

Distribution of pathogen species and antibiotic resistance of pathogens from intravenous catheter-related bloodstream infections in pediatric intensive care unit

目的 了解儿科重症监护病房（PICU）血管内导管相关性血流感染（CRBSIs）的临床特点、病原菌分布及其耐药性,为合理使用抗生素提供依据.方法 回顾性分析2009年9月至2014年9月在广东省人民医院PICU住院的CRBSIs患儿的临床特点、病原菌构成和药物敏感试验结果.结果 5年共使用中心静脉导管10 834 d,发生CRBSIs 23例,发病率为2.1/1 000导管日.置管时间＜7d9例（占39.1％）,8-14 d 10例（占43.5％）,14-21 d 4例（占17.4％）.革兰阳性菌13例（占56.6％）,革兰阴性菌5例（占21.7％）,真菌5例（占21.7％）.引起CRBSIs的主要病原菌依次为凝固酶阴性葡萄球菌（7株,占30.4％）、金黄色葡萄球菌（3株,占13.0％）、白色念珠菌（3株,占13.0％）、近平滑念珠菌（2株,占8.7％）、阴沟肠杆菌（2株,占8.7％）.表皮葡萄球菌等凝固酶阴性葡萄球菌未发现万古霉素、利奈唑胺、替考拉宁耐药菌株;革兰阴性杆菌对亚胺培南、哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感率均为100％;白色念珠菌、近平滑念珠菌对两性霉素B、5-氟胞嘧啶、氟康唑、伏立康唑敏感率均为100.0％.21例（91.3％）曾用抗生素,2例（8.7％）未用.真菌感染者平均使用抗生素4.4种,细菌为1.4种.曾用1种的10例（43.5％）,2种的4例（17.4％）,3种的4例（17.4％）,3种以上的5例（21.7％）.痊愈22例（95.7％）,死亡1例（4.3％）.结论 PICU内CRBSIs病原菌以凝固酶阴性葡萄球菌为主,延长导管留置时间且频繁使用多种抗生素者,需警惕真菌感染.规范使用抗菌药物,缩短置管时间是预防CRBSIs的有效措施,监测CRBSIs病原菌分布和药敏变迁有助于早期经验性用药.

Objective To investigate the clinical characteristics,distribution and drug sensitivity of pathogens causing intravenous catheter-related bloodstream infections （CRBSIs） in pediatric intensive care unit （PICU） so as to use antibiotics reasonably.Methods All patients with CRBSIs in PICU of Guangdong General Hospital from September 2009 to September 2014 were investigated and the drug resistance profiles of pathogens causing CRBSIs were also analyzed retrospectively.Results Between 2009 and 2014,there were totally 10 834 catheter days and 23 episodes of CRBSIs with an incidence of 2.1 infections per 1 000 catheter days.Catheter indwell time 〈 7 days in 9 cases （39.1%）,8 to 14 days in 10 cases （43.5%）,14 to 21 days in 4 cases （17.4%）.There were 13 strains （56.6%） of gram-positive bacteria,5 strains （21.7%） of gram-negative bacteria and 5 strains （21.7%） of fungi.The main pathogens causing CRBSIs were coagulase negative Staphylococci （7 strains,30.4%）,Staphylococcus aureus （3 strains,13.0%）,Candida albicans（3 strains,13.0%）,Candida parapsilosis（2 strains,8.7%）,and Enterobacter cloacae （2 strains,8.7 %）.The susceptibility to Vancomycin,Linezolid and Teicoplanin of coagulase negative Staphylococ cus such as S.epidermidis and to Imipenem,Piperacillin/Tazobactam,Cefoperazone/ Sulbactam and Amikacin of gram-positive bacteria arrived at 100.0%,respectively.The candida were 100% susceptible to Amphotericin B,5-Flucytosine,Fluconazole and Voriconazole.Twenty-one cases （91.3%） received antibiotic treatment versus no antibiotic in 2 cases （8.7%）.The average number of antibiotic kinds administered on the patients with fungal infection was 4.4,bacteria were 1.4.Ten cases （43.5%） treatment with 1 kind of antibiotic,4 cases （17.4%） with 2,4 cases （17.4%） with 3,5 cases （21.7%） with more than 3.Twenty-two cases （95.7%） cured and 1 case died （4.3%）.Conclusions The major species of pathogen causing CRBSIs was coagulase negative staphylococci in PICU.It is critical for clinicians to guard against fungal infection because of prolonged catheter indwelling time and more antibiotics administered before indwelling catheter.It is effective way to prevent the CRBSIs by reasonably using antibiotics and shortening the time of catheter indwelling.Monitoring CRBSIs pathogenic bacteria distribution and drug susceptibility helps reasonable administration of antibiotics in the earlier time.