200例败血症病原菌分布特征及耐药性分析

Pathogen Distribution and Drug Resistance Analysis of 200 Cases of Sepsis

目的探究我院200例败血症患者病原菌的种类及构成比,并通过耐药性分析探究主要菌种的耐药率,为败血症的临床诊断与治疗提供理论依据。方法选择2014年2月—2017年2月于武汉大学人民治疗的200例败血症患者,所有患者均进行血液标本采集,通过BD9120全自动血培养仪进行细菌分离培养,观察病原菌种类及构成比等分布特征。采用美国BD全自动微生物鉴定药敏分析系统进行耐药性分析,分别检测革兰阳性菌以及革兰阴性菌主要菌种对一般抗菌药物的耐药性。结果 200例败血症患者的血液标本中总检出病原菌220株,其中革兰阴性菌所占比例最大,共143株(占65.00%);其中排名前4位分别为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌以及阴沟杆菌,所占比例分别为18.18%(40/220)、17.27%(38/220)、6.36%(14/220)、5.45%(12/220)。革兰阳性菌65株(29.55%);其中排名前3位分别为凝固酶阴性葡萄球菌、金黄色葡萄球菌以及肠球菌属,所占比例分别为17.73%(39/220)、5.45%(12/220)、4.55%(10/220)。真菌12株(占5.45%)。革兰阴性菌中大肠埃希菌超广谱β-内酰胺酶检出率为68.42%(26/38)、肺炎克雷伯菌为22.50%(9/40),革兰阳性菌中金黄色葡萄球菌甲氧西林耐药株比例为25.00%(3/12)、凝固酶阴性葡萄球菌为82.05%(32/39);败血症患者血液内革兰阴性菌、革兰阴性菌主要菌株对常用抗菌药物均表现出不同程度的耐药性,分别对亚胺培南、万古霉素敏感性最高。结论感染败血症患者病原菌以革兰阴性菌为主,其次为革兰阳性菌,真菌感染所占比例极小,耐药性分析分析情况不容乐观,对常用抗菌药物均表现出不同程度的耐药性,临床上需要根据病原菌分布特征及耐药性分析结果使用合理的抗生素治疗,同时要避免抗生素的不规范使用。

Objective To study species and constituent ratio of pathogen of 200 cases of patients with sepsis and to study drug resistance rate of major bacteria via drug resistance analysis,so as to provide theory gist for clinical diagnosis and treatment of sepsis. Methods 200 cases of patients with sepsis treated in People's Hospital of Wuhan University since February2014 to February 2017 were selected as the object of study. All patients were collected for blood samples which were separately cultured for bacteria via BD9120 automatically blood culture instrument and were observed for species and constituent ratio and other distributions of pathogen. Drug resistance analysis was conducted via American BD Compact automatically bacteria identification and drug sensitivity analysis system and were respectively detected for drug resistance of gram-positive bacterium and gram negative bacterium and other major bacteria against antimicrobial. Results Among 200 cases of patients with sepsis,there were 220 strains of pathogens detected in blood samples,in which the ratio of gram negative bacterium was greatest with 143 strains and a proportion for 65. 00%. The top four of constituent ratio included klebsiella pneumoniae, escherichia coli,pseudomonas aeruginosa and cloaca entero bacter whose proportion were 18. 18%( 40/220),17. 27%( 38/220),6. 36%( 14/220),5. 45%( 12/220) respectively. There were 65 strains of gram positive bacteria with proportion for 29. 55%,and the top three of constituent ratio included coagulase-negative staphylococci, staphylococcus aureus and enterococcus with proportion for 17. 73%( 39/220),5. 45%( 12/220),4. 55%( 10/220) respectively. There were 12 strains of funguses with proportion for 5. 45%. The detection rate of escherichia coli spectrum β-lactamase producing in gram negative bacterium was 68. 42%( 26/38),and that of Klebsiella pneumoniae was 22. 50%( 9/40). The proportion of drug resistance strains of methicillin resistant staphylococcus aureus in gram positive bacterium was 25. 00%( 3/12),and that of coagulase-negative staphylococci was 82. 05%( 32/39). The drug resistance of gram negative bacterium and gram positive bacterium and other major bacteria in blood of patients with sepsis against antimicrobial was different, and the sensitivity over imipenem and vancomycin was the highest. Conclusion The pathogens of patients with sepsis are mainly constituted with gram negative bacterium,and then gram positive bacterium with small proportion of fungal infection. The result of drug resistance analysis is not optimistic and there are different degrees of drug resistance against conventional antimicrobial. Antibiotic shall be applied in accordance with pathogen distribution and drug resistance for treatment in clinic and the abuse of antibiotic shall be avoid.