48例厌氧菌血流感染的临床特点及耐药性分析

Clinical characteristics and drug resistance of 48 cases with anaerobic bloodstream infections

目的探讨厌氧菌血流感染的临床特点及耐药性,提高厌氧菌血流感染的诊断和治疗。方法选取2012年1月至2015年12月本院48例厌氧菌血流感染者为研究对象,分析患者临床特征、细菌种类及耐药性。结果消化系统疾病和外科术后感染是厌氧菌血流感染的主要原因。共检出53株厌氧菌,革兰阳性和革兰阴性厌氧菌的比例分别为47.17%和52.83%,其中消化链球菌属占20.75%,脆弱拟杆菌占15.09%,其他拟杆菌属占22.64%。革兰阴性厌氧菌的报阳时间多在48 h以内,早于革兰阳性厌氧菌。53株厌氧菌中对哌拉西林/他唑巴坦、亚胺培南和万古霉素均100.00%敏感;拟杆菌属中仅7株对青霉素敏感,敏感率为35.00%和13株对克林霉素敏感,敏感率为65.00%;8株革兰阳性厌氧杆菌和12株革兰阳性厌氧球菌对甲硝唑敏感,敏感率分别为63.64%和85.71%。结论厌氧菌血流感染以革兰阴性菌为主,血培养是临床厌氧菌感染的主要检测手段,加强厌氧菌监测和抗菌药物敏感试验可有效降低厌氧菌血流感染的发生率和病死率。

Objective To investigate the clinical characterisitics and the resistance of anaerobic bloodstream infections and to improve the diagnosis and treatment in anaerobic bacteremia. Methods Total of 48 cases with anaerobic bloodstream infections in our hospital were collected from January 2012 to November 2015. The clinical characterisitics, pathogens distribution and drug resistance were analyzed, respectively. Results The most pathogenesis of anaerobic bloodstream infections were gastrointestinal tract diseases and surgical site infections. Total of 53 strains anaerobic bacteria were isolated, and the detection rates of Gram-positive and Gram-negative anaerobic bacteria were 47.17% and 52.83%, which included Peptostreptococcus spp. （20.75%）, Bacteroides fragilis （15.09%） and other Bacteroides spp. （22.64%）. The positive alarming time within 48 h of Gram-negative anaerobic bacteria was significantly shorter than that of Gram-positive anaerobic bacteria. Among the 53 strains anaerobic bacteria, 100.00% were susceptible to pipperacillin-tazobactam, imipenem and vancomycin. Only 7 isolates ofBacteroides spp. were susceptible to penicillin （35.00%）, 11 isolates were susceptible to clindamycin （65.00%）. Eight isolates of Gram-positive bacilli （66.67%） and 11 isolates of Gram-positive cocci （86.67%） were susceptible to metronidazoleand. Conclusions The anaerobic bloodstream infections were majored in Gram-negative bacilli. Blood culture played a significant role in anaerobic blood infections. It was important to increase the detection rates of anaerobic bacteria and provide the antimicrobial susceptibility testing in order to reduce the incidence and mortality of anaerobic bloodstream infections.