维持性血液透析患者静脉导管相关性感染的病原菌分布及药敏分析

Pathogens distribution and drug susceptibility of catheter-related infection in patients treated with maintenance hemodialysis

目的分析维持性血液透析(MHD)患者静脉导管相关性感染的相关因素、病原菌分布及药敏性,为临床治疗提供依据。方法选取2013年1月-2015年12月医院收治100例MHD患者为研究对象,对患者进行血液/分泌物培养,分析患者发生导管相关性感染的相关因素、病原菌分布及药敏结果,数据采用SPSS16.0统计软件进行分析,计量资料用均数±标准差表示,计数资料用率和百分比表示行χ~2检验,感染发生的影响因素采用logistic多因素分析,P<0.05为差异有统计学意义。结果 100例MHD患者中,15例发生导管相关性感染,感染率15.00%;患者年龄及BMI(体质量指数)与感染的发生具有显著相关性,差异有统计学意义(P<0.05);感染患者共分离出46株病原菌,其中革兰阳性菌31株占67.39%,革兰阴性菌15株占32.61%;革兰阳性菌中金黄色葡萄球菌对苯唑西林、红霉素及克林霉素等耐药率较高,均>50.00%,表皮葡萄球菌对苯唑西林、磺胺甲噁唑/甲氧苄啶及庆大霉素等耐药率较高>30.00%,肠球菌属对苯唑西林、红霉素及环丙沙星等耐药率较高,均>60.00%,主要革兰阳性菌对万古霉素等耐药率均为0,革兰阴性菌对环丙沙星、左氧氟沙星、美罗培南及亚胺培南的耐药率为0,而对哌拉西林及头孢呋辛酯的耐药率较高。检出菌株中鲍氏不动杆菌对10类抗菌药物耐药,而铜绿假单胞菌对12类抗菌药物耐药。结论 MHD患者导管相关性感染的病原菌存在多药耐药现象,提示导管相关性感染的治疗需要以药敏检查结果为依据。

OBJECTIVE To analyze the related factors,pathogens distribution and drug susceptibility of catheter-related infection in patients treated with maintenance hemodialysis（MHD）,so as to provide basis for clinical treatment.METHODS From Jan.2013 to Dec.2015,100 patients treated with MHD were chosen as study objects,and the blood/secretion cultivation results were observed.The related factors,pathogens distribution and drug susceptibility of catheter-related infection in patients were analyzed.The data were analyzed by SPSS16.0statistical software.The measurement data were expressed as mean ± standard deviation.Theχ~2test was used for comparing rate and percentage.The risk factors of infection were analyzed by logistic multivariate analysis,and P〈0.05 was considered statistically significant.RESULTS Totally 15patients（15.00%）were diagnosed with catheter-related infection,which demonstrated significant relativity with age and BMI of patients,and the difference was statistically significant（P〈0.05）.Totally 46 strains of bacteria were isolated,including 31strains（67.39%）of grampositive bacteria and 15strains（32.61%）of gram-negative bacteria.Among gram-positive bacteria,Staphylococcus aureus exhibited high drug resistant rates to oxacillin,erythromycin and clindamycin,which were higher than50.00%,the resistant rate of Staphylococcus epidermidis to oxacillin,sulfamethoxazole/trimethoprim and gentamicin were higher than 30.00%,the resistant rates of Enterococcus to oxacillin,erythromycin and ciprofloxacin were all higher than 60.00%,and they were sensitive to vancomycin,with the drug resistant rates of 0.00%.Gram-negative bacteria were sensitive to ciprofloxacin,levofloxacin,imipenem and meropenem,while were resistant to piperacillin and cefuroxime axetil.Acinetobacter baumannii was resistant to 10 kinds of antimicrobials,while Pseudomonas aeruginosa was resistant to 12 kinds of antimicrobials.CONCLUSIONPathogens isolated from patients with catheter-related infection were multiple drug-resistant,which suggested that the treatment of catheter-related infection should be based on the results of drug susceptibility testing.