体外膜肺氧合辅助患者医院感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infections in patients treated with extracorporeal membrane oxygenation

目的调查体外膜肺氧合(ECMO)辅助患者医院感染致病菌分布及耐药性,为合理应用抗菌药物提供依据。方法回顾性分析2012年1月-2013年12月心脏外科重症监护病房(ICU)收治的167例因急性心肺功能衰竭接受ECMO辅助患者,分析其各种标本所分离的病原菌,应用VITEK-Jr全自动细菌鉴定及药敏分析系统鉴定细菌类别,采用纸片扩散(K-B)法进行药敏试验。结果 167例患者中42例发生医院感染,感染率为25.1%;共分离病原菌115株,其中革兰阴性杆菌86株占74.8%,革兰阳性球菌18株占15.6%,真菌11株占9.6%;呼吸道分离84株占73.0%,血液分离28株占24.4%,其他部位分离3株占2.6%;不动杆菌属仅头孢哌酮/舒巴坦、替加环素有较好的抗菌活性,耐药率分别为11.8%、0;铜绿假单胞菌对亚胺培南、左氧氟沙星和美罗培南的耐药率分别为13.3%、13.3%、20.0%,未发现耐万古霉素及利奈唑胺的葡萄球菌。结论革兰阴性杆菌是ECMO辅助患者医院感染主要致病菌,不动杆菌属呈现多药耐药。

OBJECTIVE To investigate the distribution and drug resistance of pathogenic bacteria causing nosocomi‐al infections in patients treated with extracorporeal membrane oxygenation （ECMO） so as to provide guidance for reasonable use of antibiotics .METHODS A total of 167 patients with acute heart and lung failure who received the ECMO in the intensive care unit （ICU） of cardiac surgery department from Jan 2012 to Dec 2013 were retrospec‐tively analyzed .The pathogens isolated from various specimens were observed ,the bacterial identification was car‐ried out by using VITEK‐Jr automatic bacterial identification system and drug susceptibility analysis system ,and the drug susceptibility testing was performed with the use of disk diffusion （K‐B） method .RESULTS Of 167 pa‐tients ,42 cases had nosocomial infections with the infection rate of 25 .1% .Totally 115 strains of pathogens were isolated ,including 86 （74 .8% ） strains of gram‐negative bacilli ,18 （15 .6% ） strains of gram‐positive cocci ,and 11 （9 .6% ） strains of fungi .Of the isolated pathogens ,84 （73 .0% ） strains were isolated from respiratory tract , 28 （24 .4% ） strains were isolated from blood ,and 3 （2 .6% ） strains were isolated from other sites .The Acineto‐bacter spp showed good antibacterial activity against cefoperazone‐sulbactam and tigecycline ,with the drug resist‐ance rates of 11 .8% and 0 ,respectively ;the drug resistance rates of the Pseudomonas aeruginosa to imipenem , levofloxacin ,and meropenem were 13 .3% ,13 .3% ,and 20 .0% ,respectively ;the vancomycin‐or linezolid‐resist‐ant Staphylococcus strains were not found .CONCLUSION The gram‐negative bacilli are dominant among the pathogens causing the nosocomial infections in the patients receiving ECMO .The Acinetobacter spp strains are multidrug‐resistant .