神经外科重症监护病房患者中心静脉导管相关血流感染病原菌分析

Pathogen profile of central venous catheter-related blood stream infections in neurosurgical intensive care unit patients

目的调查分析神经外科重症监护病房(NSICU)患者中心静脉导管相关血流感染的病原菌及其耐药性,为临床预防治疗提供依据。方法回顾性分析2014年1月-2017年1月解放军火箭军总医院NSICU452例中心静脉置管患者的临床资料,调查中心静脉导管相关血流感染的发生率、病原菌分布和药物耐药性情况。结果 452例中心静脉置管患者中发生中心静脉导管相关血流感染21例,感染率4.6%。股静脉部位置管感染率(10.5%)高于颈内静脉(4.0%)和锁骨下静脉(2.6%),三者比较差异有统计学意义(χ2=9.755,P=0.008)。发生中心静脉导管相关血流感染的患者中共分离鉴定出病原菌26株,其中革兰阳性菌13株(50.0%),革兰阴性菌11株(42.3%),真菌2株(7.7%)。革兰阳性菌中以表皮葡萄球菌(5株)、金黄色葡萄球菌(3株)最常见;革兰阴性菌中以肺炎克雷伯菌(4株)、黏质沙雷菌(3株)最常见;真菌为白念珠菌和近平滑念珠菌各1株。引起中心静脉导管相关血流感染的主要病原菌前2位是表皮葡萄球菌(19.2%)、肺炎克雷伯菌(15.4%);13株革兰阳性菌对青霉素、红霉素、苯唑西林、克林霉素有较高的耐药率;11株革兰阴性菌对头孢唑林、哌拉西林有较高的耐药率;2株念珠菌对氟康唑、伏立康唑、伊曲康唑、两性霉素B等药物高度敏感。结论 NSICU中心静脉导管相关血流感染病原菌中以革兰阳性菌为主,表皮葡萄球菌最为常见,革兰阴性菌中以肺炎克雷伯菌较为常见,且耐药率均较高。临床应注意无菌操作,并依据药敏试验结果选择合理的抗菌药物,减缓耐药性的产生。

Objective To explore the distribution and antibiotic resistance of the pathogens in the patients with central venous catheter-related blood stream infection in neurosurgical intensive care unit （NSICU）. Methods A total of 452 patients with central venous catheter were identified in NSICU from January 2014 to January 2017. Medical records were reviewed retrospectively to examine the incidence of central venous catheter-related blood stream infections, and the pathogen distribution and antibiotic resistance？profle.？Results The incidence of central venous catheter-related blood stream infection was 4.6% （21/452）. The incidence of？such？infection？was？signifcantly？higher？for？the？catheter？in？femoral？vein？（10.5%）？than？in？internal？jugular？vein？（4.0%）？and？subclavian？vein （2.6%） （ χ2=9.755, P=0.008）. Twenty-six strains of pathogen were isolated from the 21 patients, including 13 （50.0%） gram-positive bacteria, 11 （42.3%） gram-negative bacteria and 2 （7.7%） fungal strains （Candida albicans and Candida parapsilosis each）. The most common gram-positive bacteria were Staphylococcus epidermidis（5） and Staphylococcus aureus（3）. The most commongram-negative bacteria were Klebsiella pneumoniae（4） and Serratia marcescens（3）. The most frequently isolated pathogen of central venous catheter-related blood stream infections was S. epidermidis （19.2%） and K. pneumoniae （15.4%）. The antimicrobial susceptibility testing showed that gram-positive bacteria were highly resistant to penicillin, erythromycin,oxacillin and clindamycin. Gram-negative bacteria were highly resistant to cefazolin and piperacillin. The two fungal strain were highly？sensitive？to？fuconazole,？voriconazole,？itraconazole？and？amphotericin？B.？Conclusions The predominant pathogens of central venous catheter-related blood stream infections in NSICU patients are gram-positive bacteria. S. epidermidis and K. pneumoniae are the major pathogens with high level of antibiotic resistance. Aseptic procedures and rational antibiotic therapy according to antimicrobial susceptibility test should be emphasized to control the resistant strains.