2012-2014年锁骨下静脉导管感染病原菌分布及耐药性分析

Distribution and drug-resistance of pathogens causing subclavian intravenous catheter-related infection from 2012 to 2014

目的了解锁骨下静脉导管感染病原菌的分布及其耐药情况,为临床治疗提供参考依据。方法回顾性分析我院2012年1月至2014年12月锁骨下静脉导管培养出的病原菌分布及其耐药性。结果送检的332份标本中,培养阳性123份,阳性率为37.0%。检出的病原菌中革兰阴性杆菌82株(66.7%),革兰阳性球菌36株(29.3%),真菌5株(4.0%)。前3位的细菌为鲍曼不动杆菌、凝固酶阴性葡萄球菌、肺炎克雷伯杆菌,分别占36.6%、23.6%、8.1%。检出的鲍曼不动杆菌对美罗培南、头孢他啶、阿米卡星的耐药率均>75%,对头孢哌酮/舒巴坦、米诺环素的耐药率略低,分别为46.7%、48.9%。凝固酶阴性葡萄球菌中MRCNS(耐甲氧西林凝固酶阴性葡萄球菌)占比82.8%,未发现对达托霉素、利奈唑胺、万古霉素耐药的革兰阳性球菌。肺炎克雷伯杆菌中产ESBLs菌株占80.0%,耐碳青霉烯类菌株占20.0%。结论我院锁骨下静脉导管感染的病原菌耐药性严重,临床医生应规范操作、合理用药,减少耐药株的产生。

Objective To study the distribution and drug-resistance of pathogens isolated from subclavian intravenous catheter infection,so as to provide evidence for clinical treatment.Methods The pathogens isolated from subclavian intravenous catheter infection from Jan 2012 to Dec 2014 were retrospectively analyzed in terms of the distribution and drug resistance.Results Of all the 332 samples,123samples（37.0%）were pathogen-positive,among which 82 strains were gram-negative（66.7%）,36 strains were gram-positive（29.3%）,and 5strains were fungi（4.0%）.The top three pathogens were Acinetobacter baumanni,coagulase negative Staphylococci and Klebsiella pneumonia,respectively accounting for 36.6%,23.6%and 8.1%.The drug-resistance rates of Acinetobacter baumanni to Meropenem,Ceftazidime and Amikacin were greater than 75%,to Cefperazone-Sulbactam and Minocycline were 46.7% and 48.9% respectively.Methicillin resistant coagulase negative Staphylococci accounted for 82.8% among coagulase negative Staphylococci.No Gram-positive cocci were found resistant to Daptomycin,Linezolid and Vancomycin.Extended spectrum beta-lactamase positive strains and carbapenem-resistant strains accounted for 80.0% and20.0% respectively among Klebsiella pneumonia.Conclusion Drug resistance of the pathogens isolated from subclavian intravenous catheter infection is very serious.Clinicians should standardize operation and rationally use antibiotics to reduce the generation of drug-resistant strains.