心脏外科患者感染病原菌的耐药性监测分析

Drug resistance monitoring of pathogenic bacteria in patients with cardiac surgery

目的调查医院心脏外科患者感染病原菌的现状,分析病原菌耐药性及患者抗菌药物的选择应用情况,为临床研究和医师选择抗菌药物提供参考依据。方法选择2015年6月-2016年6月医院心脏外科患者200例,分别对患者的临床资料、细菌耐药性和抗菌药物使用进行回顾性调查,并对药物选择的合理性和相关性进行分析。结果 200例患者术后共发生感染35例,感染率为17.5%;感染患者标本培养出病原菌92株,以革兰阴性菌为主53株,占57.61%,其中肺炎克雷伯菌最多18株,占19.57%;革兰阳性球菌33株,占35.87%,其中金黄色葡萄球菌最多17株,占18.48%;肺炎克雷伯菌、铜绿假单胞菌与大肠埃希菌对亚胺培南有较高的敏感性,耐药率分别为22.22%、16.67%与16.67%;鲍氏不动杆菌对亚胺培南、头孢他啶、磺胺甲噁唑/甲氧苄啶有较高的敏感性,耐药率均为25.00%;金黄色葡萄球菌、表皮葡萄球菌对万古霉素与替考拉宁有较高的敏感性;表皮葡萄球菌、肺炎链球菌与粪肠球菌对替考拉宁的耐药率均为0。结论医院心脏外科患者感染病原菌以铜绿假单胞菌为主,该病原菌对广谱抗菌药物耐药性有加强趋势,因此,强化该类感染的临床监测,根据患者标本药敏结果合理选择抗菌药物对提高患者的治疗效果、减轻用药压力具有重要意义。

OBJECTIVE To investigate the situation of pathogenic bacteria infection in patients with cardiac surgery,analyze drug resistance and selection and usage of antimicrobial drug in patients,so as to provide references for the selection of antibiotics for clinical research and physicians.METHODS A total of 200 cases of cardiac surgery patients in our hospital from Jun.2015 to Jun.2016 were selected.The clinical data,bacterial resistance and usage of antimicrobial drug were investigated retrospectively,and the rationality and correlation of drug selection was analyzed.RESULTS Totally 35 cases occurred infection in 200 cases of patients,with the infection rate of 17.5 %.Totally 92 strains of pathogens were isolated from infected specimens.The gram-negative bacteria were the main pathogens,and 53 strains were isolated,accounting for 57.61%,which were mainly 18 strains of Klebsiella pneumoniae,accounting for 19.57%.There were 33 strains of gram positive bacteria,,accounting for 35.87%,which were mainly 17 strains of Staphylococcus aureus,accounting for 18.48%.K.pneumoniae,Pseudomonas aeruginosa and Escherichia coli had high sensitivity to imipenem,with the resistant rates of 22.22%,16.67% and 16.67 %.A.baumannii had high sensitivity to imipenem,ceftazidime,sulfamethoxazole/ trimethoprim,with the resistant rate of 25.00%.S.aureus and S.epidermidis were sensitive to vancomycin and teicoplanin.The drug resistant rates of S.epidermidis,Streptococcus pneumoniae and Enterococcus faecalis to teicoplanin were all 0.CONCLUSION P.aeruginosa is the main pathogenic bacteria of infection in cardiac surgery patients in hospital,the drug resistance of pathogenic bacteria to broad spectrum antimicrobials has the tendency to enhance,so it is of great significance to strengthen the clinical monitoring of this kind of infection,and rationally select antimicrobials according to the results of drug sensitivity test for improving the treatment effect of patients and reducing medication pressure.