我院102例老年血流感染患者病原菌的分布特点及其耐药性

Distribution and drug resistance of pathogenic bacteria in 102 elderly patients with bloodstream infection in our hospital

目的分析我院102例老年血流感染(BSI)患者病原菌分布特点和耐药性。方法收集2014年3月至2017年3月我院437例老年(年龄≥65岁)BSI患者血液样本,分析其细菌培养结果和药敏情况。结果 437份血液标本中,分离得到102株病原菌,阳性率23.34%,其中革兰阴性菌占50.98%,革兰阳性菌占37.25%,真菌占11.76%。在革兰阴性菌中,大肠埃希菌ESBLs检出率47.05%,肺炎克雷伯菌ESBLs检出率45.45%,药敏结果显示,大多数β内酰胺酶抑制剂复合物及碳青酶烯类对革兰阴性菌具有较好抗菌活性;在革兰阳性菌中,14株金黄色葡萄球菌中MRSA检出率71.43%,18株凝固酶阴性葡萄球菌中MRCNS检出率77.78%,药敏结果显示,利福平、四环素、万古霉素和替考拉宁具有较好抗菌活性;真菌均为假丝酵母菌,以白色假丝酵母菌和热带假丝酵母菌为主,均对伊曲康唑和两性霉素B敏感。结论老年BSI病原菌分布较广,以肠杆菌和葡萄球菌为主,革兰阴性菌和阳性菌耐药情况不容乐观,需加强病原菌变化及耐药性监测,指导临床合理用药。

AIM To analyze the distribution and drug resistance of pathogenic bacteria in 102 elderly pa- tients with bloodstream infection （BSI） in our hospital. METHODS The blood samples of 437 elderly patients （ I〉65 years old） with BSI treated in the hospital from March 2014 to March 2017 were collected, and the results of bacterial culture and drug sensitivity test were analyzed. RESULTS A total of 102 strains of distinct pathogen- ic bacteria were isolated from 437 blood samples, and the positive rate was 23.34% , of which gram negative bacte- ria accounted for about 50.98% , gram positive bacteria accounted for about 37.25% and fungi accounted for about 11. 76%. In gram negative bacteria, the extended spectyum β lactamases （ESBLs） detection rate of Escherichia coli was 47.05% , and that of Klebsiella pneumoniae was 45.45%. The results of drug sensitivity test showed that the β-lactams, β-lactamase inhibitor complexes and carbapenems were with good antibacterial activity against gram negative bacteria. In gram positive bacteria, the MRSA detection rate of 14 strains of Staphylococcus aureus was 71.43% , and MRCNS detection rate of 18 strains of coagulase negative Staphylococcus was 77.78%. The results of drug sensitivity test showed that rifampicin, tetracycline, vancomycin and teicoplanin were with good antibacterial activity. All of the fungi were Candida albicans, and Candida albicans and Candida tropicalis were all sensitive to itraconazole and amphotericin B. CONCLUSION Pathogenic bacteria of BSI are widely distributed in the elderly. Enterobacteriaceae and Staphylococci are the main pathogens. The drug resistance of gram negative bacteria and gram positive bacteria is not optimistic . The monitoring of changes in pathogenic bacteria and drug resistance need to be strengthened to guide the clinical medication.