重症监护病房导管相关血流感染的病原菌分布与耐药分析

Distribution and antibiotic resistance of pathogens causing catheter-related bloodstream infections in ICU

目的了解重症监护病房(ICU)导管相关血流感染病原菌分布及耐药状况,为临床治疗提供依据。方法对2009年1月—2014年12月ICU留置导管患者引起导管相关血流感染的病原菌及其耐药性进行回顾性分析。结果导管相关血流感染病原菌以革兰阴性杆菌为主,占52.7%,革兰阳性球菌占41.4%,真菌占5.9%。检出率依次为凝固酶阴性葡萄球菌占21.9%,金黄色葡萄球菌(金葡菌)占15.4%,鲍曼不动杆菌占15.3%,肺炎克雷伯菌占13.6%、大肠埃希菌占10.1%,铜绿假单胞菌占8.3%等。鲍曼不动杆菌、铜绿假单胞菌多表现为多重耐药(MDR)和广泛耐药(XDR)。肺炎克雷伯菌、大肠埃希菌多为超广谱β内酰胺酶阳性株且表现为MDR。凝固酶阴性葡萄球菌、金葡菌则多为甲氧西林耐药株。结论掌握ICU导管相关血流感染病原菌的临床分布及耐药特点,对有效控制和预防导管相关血流感染非常必要。

Objective To understand the distribution and antibiotic resistance of pathogens causing catheter-related bloodstream infections in ICU for better clinical treatment.Methods The catheter-related bloodstream infections identified in ICU during the period from January 2009 to December 2014 were reviewed retrospectively in terms of pathogens and antibiotic resistance profile.Results The pathogens of catheter-related bloodstream infections were primarily gram negative bacilli（52.7%）,gram positive cocci（41.4%）,and fungi（5.9%）.Specifically,coagulase negative Staphylococcus accounted for 21.9%,followed by Staphylococcus aureus（15.4%）,Acinetobacter baumannii（15.3%）,Klebsiella pneumoniae（13.6%）,Escherichia coli（10.1%）,and Pseudomonas aeruginosa（8.3%）.Most of the A.baumannii and P.aeruginosa strains were multidrug resistant or extensively drug-resistant.Most of the K.pneumoniae and E.coli strains produced ESBLs and exhibited resistance to multiple antimicrobial agents.Most coagulase negative Staphylococcus and S.aureus were methicillin-resistant.Conclusions It is necessary to understand the distribution and antibiotic resistance of the pathogens causing catheter-related blood stream infections in ICU for better control and prevention of such infections.