严重脓毒症和脓毒性休克患者血流感染病原菌分布及耐药性分析

Distribution and drug resistance analysis of bloodstream infection pathogens in patients with severe sepsis and septic shock

[目的]分析严重脓毒症和脓毒性休克患者血流感染病原菌分布及耐药性.[方法]回顾性分析2012年6月至2015年6月间入住ICU时符合严重脓毒症和(或)脓毒性休克诊断标准的182例患者的临床资料,观察患者感染部位并分析血流感染病原菌分布及耐药性.[结果]肺部感染最常见,发生率为64.8%(118/182),其次为腹腔感染、泌尿系统感染、皮肤或软组织感染及脑膜炎等.总血培养阳性率为48.9%(89/182).共分离出95株细菌,其中革兰氏阴性菌54株(56.8%),主要为大肠埃希菌(26株,27.3%)及肺炎克雷伯菌(11株,11.6%);革兰氏阳性菌41株(43.2%),主要为凝固酶阴性葡萄球菌(29株,30.5%)及金黄色葡萄球菌(10株,10.5%);未分离出对万古霉素耐药的金黄色葡萄球菌分离株,亦未检测出对亚胺培南和美罗培南耐药的大肠埃希菌和肺炎克雷伯菌.大部分病原菌对常用抗菌药物耐药.[结论]严重脓毒症和脓毒性休克患者感染部位以肺部为多见,血流感染病原菌以革兰氏阴性菌为主,耐药性较普遍.

OBJECTIVE To analyze the distribution and drug resistance of bloodstream infection pathogens in patients with severe sepsis and septic shock. METHODS The retrospective analysis was performed in 182 ICU patients who were diagnosed severe sepsis and（or） septic shock from June 2012 to June 2015. The infection sites were observed and the distribution and drug resistance of bloodstream infection pathogens were analyzed. RESULTS Pulmonary infection was the most common, accounting for 64.8% （118/182）, followed by abdominal infection, urinary tract infection, skin and soft tissue infection and meningitis, etc. The positive rate of total blood culture was 48. 9% （89/182）. 95 strains were isolated, of which 54 strains were gram-negative bacteria, accounting for 56. 8% and mainly Escherichia coli （26 strains, 27.3%） and Klebsiella pneumoniae （11 strains, 11.6%） ~ 41 strains were gram-positive bacteria, accounting for 43.2% and mainly the Coagulase negative staphylococci （29 strains, 30.5 % ） and Staphylococcus aureus （10 strains 10.5%）; Staphylococcus aureus strain which was resisted to vancomycin was not isolated, and Escherichia coli and Klebsiella pneumoniae strains which were resisted to imipenem and meropenem were not detected either. Most of the pathogens were resistant to the commonly used antimicrobial drug. CONCLUSION The primary infection site of the patients with severe sepsis and septic shock was lung, and the main pathogens of bloodstream infection were the gram-negative bacteria, while drug resistance was relatively common.