导管相关血流感染的病原体特征分析

Pathogen Characteristics of Catheter-related Bloodstream Infection

目的了解导管相关血流感染(catheter-related bloodstream infection,CRBSI)的病原体特征,为预防和治疗该类感染提供依据。方法回顾性分析2011年1月1日至2014年10月15日期间,四川大学华西医院住院患者中发生CRBSI患者的临床资料及其标本的病原学培养与药敏实验结果。结果从77例CRBSI患者的标本中共分离到84株病原菌,其中革兰阴性菌41株(占48.8%),革兰阳性菌23株(占27.4%),真菌20株(占23.8%);革兰阴性菌中肠杆菌科细菌居多(29/41,70.7%),非发酵菌次之(12/41,29.3%);革兰阳性菌以葡萄球菌属为主(16/23,69.6%);真菌中白色念珠菌稍多(7/20,35.0%)。药敏实验结果显示,肠杆菌科对头孢曲松的耐药率最高(65.5%),对亚胺培南耐药率最低(3.4%);非发酵菌对呋喃妥因的耐药率最高(100.0%),对左氧氟沙星耐药率最低(16.7%);葡萄球菌属对克林霉素耐药率最高(81.3%),对万古霉素和利奈唑胺均敏感;未发现对两性霉素和5-氟胞嘧啶耐药的念珠菌。结论应在我院加强预防和控制由革兰阴性杆菌引起的CRBSI,并依据该类病原菌的体外敏感性指导临床治疗。

Objective To determine thepathogen characteristics of catheter-related bloodstream infection （CRBSI）. Methods The clinical data of patients with CRBSI who were admitted in West China Hospital, Sichuan University during January 1, 2011 and October 15, 2014 were retrieved, along with findings of pathogen culture and drug susceptibility tests. Results Eighty-four strains of pathogens were isolated from 77 patients, which included 41 strains （48. 8%） of Gram-negative bacteria, 23 strains （27. 4%） of Gram-positive bacteria, and 20 strains of fungus （23.8%）. Enterobacteriaceae was predominant （29/41, 70.7%） in the Gram-negative bacteria,followed by non-fermenting bacteria （12/41, 29.3%）. Staphylococcus spp. was the main （16/23, 69.6%） species of Grampositive bacteria. Candida albicans led to 35. 0% （7/20） fungi infection. Resistance of Enterobacteriaceae to ceftriaxone was high （65.5%, the highest）, compared with its resistance to imipenem （3.4%, the lowest）. The non-fermentative bacterial had complete （100 % ） resistance to nitrofurantoin, and 16.7 % resistance （the lowest）to levofloxacin. Staphylococcus spp. had 81. 3% resistance （highest） to clindamycin, and zero resistance to vancomycin andlinezolid. Resistance to amphotericin and 5-flucytosine was not found in Candida spp. isolates. Conclusion Prevention and control of CRBSI caused by Gram negative bacilli should be strengthened in the hospital. Clinical treatments should be guided by the in vitro drug susceptibility of pathogens.