827例血流感染患者的临床分布及病原谱分析

Clinical distribution and antimicrobial resistance of pathogen causing bloodstream infection in 827 patients

血流感染(Bloodstream infection,BSI)是一种严重感染性疾病,研究BSI的临床分布及病原菌流行特征,可为经验性治疗提供用药参考。分析某院2016至2018年发生BSI患者的临床资料及病原菌的耐药数据。827例BSI患者共检出病原菌863株,其中革兰阴性菌600株,占69.5%,以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌218株,占25.3%,以金黄色葡萄球菌为主;深部真菌45株,占5.2%。科室分布主要以消化内科、ICU、泌尿外科和儿科为主。儿童中0-1岁患儿BSI的发生率最高,成人中>60岁患者BSI的发生率达到了51.4%。大肠埃希菌和肺炎克雷伯菌对头孢曲松的耐药性较高,分别为53.6%和38.3%,对β-内酰胺/酶抑制剂和碳青霉烯类的耐药性较低。未检出耐万古霉素金黄色葡萄球菌,但MRSA检出率12.5%。因此,本院BSI患者病原菌分布以革兰阴性菌为主,常见细菌耐药性较为严重,年龄和科室分布存在较大差异,临床应进行分层诊疗,合理选用抗生素。

Bloodstream infections(BSI) was a severe infectious disease. Its clinical distribution and characteristics of pathogen can provide reference for clinical empirical treatment. The clinical data of patients with BSI and the drug resistance data of pathogenic bacteria of a hospital from 2016 to 2018 indicated that among the 827 BSI patients, 863 strains of pathogenic bacteria were detected, among which 600 strains of gram-negative bacteria(69.5%) were mainly Escherichia coli(E.coli) and Klebsiella pneumoniae(kpn), 218 strains of gram-positive bacteria(25.3%) were mainly Staphylococcus aureus(sau), and 45 strains of fungi(5.2%) were mainly found. The patients infected bloodstream infections(BSI) were mainly distributed in the department of gastroenterology, ICU, urology and pediatrics. The highest incidence of BIS occured in children aged 0~1 and about 51.4% inpatient adult whose age beyond 60 were affected with BIS. E.coli and kpn had higher resistance to ceftriaxone(53.6% and 38.3%, respectively), and had lower resistance to β-lactam enzyme inhibitors and carbapenems. Vancomycin resistant sau was not detected from them, but the positive rate of MRSA was 12.5%. In summary, the pathogen in BSI patients in our hospital was mainly gram-negative bacteria, and the drug resistance of common bacteria is relatively serious. There are also tremendous differences in their age and distribution of their clinical department. Therefore, stratified diagnosis and treatment should be put into practice in clinical practice and the antibiotics should be reasonably selected.