63株厌氧菌血流感染的病原菌分析及原发感染疾病调查

Pathogen analysis of 63 isolates of anaerobic bacteria for bloodstream infection and investigation of primary infectious diseases

目的了解引起血流感染的厌氧菌病原菌的分布情况及其耐药性,并调查原发感染疾病,以期指导临床有效控制厌氧菌血流感染的发生。方法采用Bac T/ALERT 3D全自动血培养仪进行血液检测,ATB鉴定仪进行病原菌鉴定和体外药物敏感性试验。结果 63株厌氧菌血流感染病原菌主要是产气荚膜杆菌(31.7%)、脆弱拟杆菌(25.4%)和具核梭杆菌(11.1%)。这些病原菌对甲硝唑、碳青霉烯类抗菌药物、氯霉素和酶抑制剂药物的耐药率均<10.0%,其中对甲硝唑的耐药率<2.0%;对青霉素类抗菌药物和克林霉素的耐药率>30.0%。革兰阳性厌氧菌对头孢西丁和头孢替坦敏感,革兰阴性厌氧菌对头孢西丁和头孢替坦的耐药率分别为15.4%和20.5%。主要原发感染疾病为肠道术后感染(22.2%)、脓胸(17.5%)和阑尾穿孔(11.1%)。结论致厌氧菌血流感染的病原菌主要是革兰阴性无芽胞厌氧杆菌和革兰阳性梭状芽胞杆菌;在药物敏感性试验结果未出来之前,临床医生可选择甲硝唑、碳青霉烯类抗菌药物和酶抑制剂作为抗厌氧菌的经验用药。引起厌氧菌血流感染的原发感染疾病主要为肠道、胸腔、女性生殖道的多种疾病,尽早做好原发疾病的防控工作,将有利于减少厌氧菌血流感染的发生和发展。

Objective To study the pathogen distribution and drug resistance of anaerobic bacteria for bloodstream infection,to investigate primary infectious diseases,and to provide a reference on controlling the occurrence of anaerobic bacterium bloodstream infection. Methods BacT/ALERT 3D automatic blood culture system was used to perform blood culturing,and ATB expression automated analysis system was used for bacterial identification and drug susceptibility. Results Among 63 isolates of anaerobic bacteria,Clostridium perfringens accounted for 31.7%,Bacteroides fragili accounted for 25.4%,and Fusobacterium fragiformisaccounted for 11.1%. The drug resistance rates to metronidazole,carbapenem,chloramphenicol and enzyme inhibitors were all 〈10.0%,and the drug resistance rate to metronidazole was 〈2.0%. The drug resistance rates to penicillin and clindamycin were 〉30.0%. Gram-positive anaerobic bacteria were susceptible to cefoxitin and cefotetan. The drug resistance rates of Gram-negative anaerobic bacteria to cefoxitin and cefotetan were 15.4% and 20.5%. The primary infectious diseases were postoperative infection after intestinal surgery（22.2%）,empyema （17.5%） and appendix perforation（11.1%）. Conclusions Gram-negative no-spore forming anaerobic bacteria and Gram-positive Clostridium are main anaerobic bacteria for bloodstream infection. When the results of drug susceptibility test were not available,the clinicians could choose metronidazole,carbapenem and enzyme inhibitors as first choice. The primary infectious diseases mainly occur in intestine,chest and female reproductive tract. It should be prevented as soon as possible,which is conducive to reducing the occurrence and development of bloodstream infection.