高压氧科血流感染病原菌分布及耐药分析

Distributions and antibiotic resistances of bloodstream infectious pathogens in the department of hyperbaric oxygen

目的探讨解放军总医院第六医学中心(以下简称"我院")高压氧科患者血流感染病原菌种类及耐药变迁情况。方法将2014年1月～2018年12月我院高压氧科发生血流感染患者266例(男175例,女91例),其送检的血液样本应用法国梅里埃BACT/ALERT 3D血培养仪进行培养,对分离出的282株病原菌应用美国布鲁克Microflex LT质谱仪和法国梅里埃VITEK 2 Compact微生物分析仪进行菌种鉴定和药敏实验。应用WHONET 5.6软件及Excel软件对数据进行分析处理。结果 5年间我院高压氧科患者血流感染病原菌以革兰阴性菌为主,占为55.0%,革兰阳性菌和真菌分别占比为40.8%和4.2%。革兰阴性菌中以肺炎克雷伯菌为主要病原菌,共计46株,占比为16.3%,其对多种抗生素耐药率较高,对碳青霉烯类抗生素耐药率达39.1%;革兰阳性菌以葡萄球菌为主,共计76株,占比为66.1%。金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素,替加环素敏感性最低,未见相应耐药株;真菌共计12株,均为念珠菌,对氟胞嘧啶、氟康唑、沃尔康唑和两性霉素B的耐药率均为0.0%。结论定期关注高压氧科患者血流感染病原菌种类及耐药变迁情况,对于指导临床医生经验性抢先治疗具有非常重要的意义。

Objective To investigate the distributions and antibiotic resistances of pathogens isolated from the patients with bloodstream infections (BSI) in Department of Hyperbaric Oxygen (HBO), the Sixth Medical Center of PLA General Hospital (“our hospital” for short). Methods There were 266 BSI cases (male 175, female 91) in the HBO department from January 2014 to December 2018. The blood samples to be inspected were cultured with BACT/ALERT 3D system of Biomerieux, France. The 282 isolated pathogens were identified and processed antimicrobial susceptibility tests with Microflex LT mass spectrometer of Bruker Daltonics, American and VITEK 2 Compact microbiology analyzer of Biomerieux, France. The data was processed and analyzed by WHONET 5.6 software and Excel software. Results Gram-negative bacteria with the isolate rate 55.0% were the predominant BSI pathogens in the HBO Department of our hospital during the 5 years, and the proportions of Gram-positive bacteria and fungi were 40.8% and 4.2%, respectively. Klebsiella pneumoniae, total 46 strains, with the ratio of 16.3% was the major one among the Gram-negative bacteria and presented the higher resistance rate to most antimicrobial, even to the Carbapenems, which was 39.1%. Staphylococcus, total 76 strains and with the ratio of 66.1%, was the major pathogen among the Gram-positive bacteria. The sensitivity of Staphylococcus aureus and Coagulase negative staphylococcus (Cons) to Vancomycin and Tigecycline were the lowest and no resistance strains were found. Totally 12 fungi were all Candida, with the resistance rates to Flucytosine, Fluconazole, Voriconazole and Amphotericin B were all 0.0%. Conclusion To regularly surveillance the distributions and antibiotic resistances of pathogens from the BSI patients in the HBO department is very significant for clinicians to perform empiric and preemptive therapy.