首都医科大学附属复兴医院2012年住院患者血流感染分析

The epidemiology of bloodstream infections in Fuxing Hospital in 2012 in Beijing

目的 了解血流感染患者的临床特征、预后及病原菌种类.方法 收集首都医科大学附属复兴医院2012年1月1日至12月31日住院患者的阳性血培养结果,分析确诊为血流感染患者的临床资料和病原菌种类.结果 血流感染患者149例,占当年出院患者18 774例次的0.8％,即当年血流感染的发生率为0.8％.首次发生血流感染时,15例（10.1％）患者来自手术科室,83例（55.7％）患者来自非手术科室,51例（34.2％）患者来自ICU.33例（22.1％）患者表现为感染性休克.住院期间死亡68例,病死率为45.6％.共发生154例次血流感染,其中医院获得性血流感染125例次（81.2％）,社区获得性血流感染29例次（18.8％）.共分离出病原菌188株,其中革兰阴性菌106株（56.4％）,革兰阳性菌67株（35.6％）,真菌15株（8.0％）.革兰阴性菌血流感染中,社区获得性血流感染更多为肠杆菌科细菌,而非发酵菌在医院获得性血流感染显著多于社区获得性血流感染.125例次医院获得性血流感染中分离出159株菌（84.6％）.188株病原菌中,26株为中心静脉导管相关性血流感染.手术科室、非手术科室、ICU的非发酵菌和肠杆菌分布差异有统计学意义（P=0.049）.结论 血流感染发生地点不同、患者所在科室不同,病原学分布差异较大.对本地区、本单位、本科室血流感染患者临床特征和病原菌分布及演变的及时了解,为临床医生经验性使用抗菌药物提供依据,以改善血流感染患者的预后。

Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections （BSIs） in a tertiary hospital.Methods Positive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.BSIS events were identified and the epidemiology data were collected.Results A total of 149 patients and 154 BSIs events were confirmed by pathogenic and clinical evidence.The inpatients＆#39; BSIs rate was 0.8% in our hospital in 2012.According to the disease entities of the first BSIs onset,15 patients （10.1%） were from surgical departments,83 patients （55.7%） from the medical departments,and 51 patients （34.2%） from ICU.Thirty-three patients （22.1%） were diagnosed as septic shock.Sixty-eight patients died during hospital stay.The in-hospital mortality rate was 45.6%.Among the 154 BSIs events,125 （81.2%） were nosocomial and 29 （18.8%） were community-acquired.A total of 188 strains were isolated from all BSIs,including 106 strains of （56.4%） gram-negative bacilli,67 （35.6%） strains of gram-positive bacteria,and 15 （8.0%） strains of fungi.One hundred and fifty-nine strains of bacteria （84.6%） were isolated from 125 events of hospital-acquired BSIs.Twenty-six strains of bacteria were from catheter related bloodstream infections （CRBSIs）.In gram-negative BSIs,there were more enterobacteriaceae in community-acquired BSIs.More non-fermentative bacteria were found in hospitalacquired BSIs than in community-acquired ones.The distribution of gram-negative bacilli was quite different between surgical departments,non-surgical departments and ICU （P =0.049）.Conclusions Pathogens of BSIs are quite different according to disease entities and where the patients are from.Local epidemiology of BSIs and distribution of related pathogens are helpful to physicians searching the optimal empirical antibiotics and improving the outcome.