系统性红斑狼疮伴感染的病原菌分布及耐药性分析

Analysis of pathogens distribution and antibiotic resistance patterns in patients with systemic lupus erythematosus along with infection

目的分析系统性红斑狼疮(SLE)住院患者伴感染的病原菌种类、分布及耐药性,为临床合理选用抗菌药物提供依据。方法选择2012年1月—2014年12月安徽医科大学附属省立医院风湿免疫科SLE伴感染的住院患者105例,利用药敏试验K-B法及细菌耐药监测软件WHONET 5.6系统对感染菌株、耐药性进行分析。结果 105例感染者共发生各部位感染133例次,感染部位以呼吸道感染所占比例最高,达42.9%,其次为泌尿系感染占22.5%;分离的148株病原菌中,前6位分别是大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌及肺炎克雷伯菌;耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、泛耐药(XDR)鲍曼不动杆菌检出率分别为76.5%、80.0%、62.5%、36.4%;革兰阴性菌耐药率≥50.0%的有氨苄西林、头孢唑林、头孢曲松、氟喹酮类和磺胺类等抗菌药物;死亡病例共9例,其中混合感染6例、合并深部真菌感染5例、全耐药(PDR)肺炎克雷伯菌1例。结论系统性红斑狼疮伴感染患者病原菌广泛复杂且耐药情况严重;应加强监测并根据药敏结果合理选用抗菌素。

Objective To analyze the pathogens distribution and antibiotic resistance patterns in patients with systemic lupus erythema- tosus （SLE） along with infection to provide scientific basis for the rational clinical use of antibacterials. Methods 105 cases of SLE patients with pathogens infection admitted to the Anhui Provincial Hospital from January 2012 to December 2014 were reviewed, and drug sensitivity test was performed by K - B paper disk diffusion method with WHONET 5.6 software for statistical analysis. Results Totally, 133 cases of infection occurred in these 105 SLE patients with various pathogens and at different sites ,with respiratory tract infections predmniuating in all these cases（42.9% ） ,followed by urinary infections （22.5%）. Meanwhile, 148 strains were isolated. The top six pathogens were Escherichia coli, Staphylococcus aureus, Coagnlase negative staphylococci （CNS） , Acinetobacter baumanmii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The detection rate of methicillin - resistant Staphylococcusarueus （ MRSA）, methicillin- resistant coagulase negative staphylococci （MRCNS）, extended spectrum β -lactamases （ESBLs） , extensively drug resistant （XDR） , and Acinetobacter baumanni were 76.5 % , 80.0 % ,62.5 % and 36.4 % , respectively. The results showed that the drug resistance rates of gram- negative bacteria to ampicillin, cefazolin, cefiriaxone,fluoroquinolones and sulfanilamides were equal to or higher than 50.0%. There were 9 cases of death,including 6 eases of mixed infectlons,5 cases of deep fungal infections,and 1 case of Klebsiella pneumoniae with pan drug resistance （PDR）. Conclusions Serious problems of＂ complex and extensive resistance exist in SLE patients with infection. The supervision and administration of the reasonable selection of antibiotics should be strengthened according to drug sensitivity test to prevent the further development and spread of resistant bacteria.