脓毒症患者病原菌分布及相关流行病学调查研究

Distribution of pathogenic bacteria in sepsis patients and related epidemiological investigation

目的研究脓毒症患者的病原菌分布情况以及相关流行病学调查。方法选取2016年9月~2018年9月在湖州师范学院附属第一医院进行治疗的脓毒症患者中的186例作为研究对象;采用回顾性分析的形式,对患者进行个人基本资料搜集,主要包括:性别、年龄、感染疾病的种类及受教育程度等;在无菌条件下,对患者血液培养样本、伤口处渗液、呼吸道处的分泌物、导管尖端的物质以及尿液进行细菌培养,进行病原菌分离鉴定分布情况;对患者的凝血指标血小板、D-Ddimer、纤维蛋白降解产物(Fibrinolytic products,FDP)、凝血酶原时间(Thrombin time,PT)、TT、部分凝血活酶时间(Partial thrombin time,APTT)的差异以及脓毒症病情严重程度(APACHE-Ⅱ评分)的关系进行分析;对脓毒症发病相关因素与发病情况的相关性进行统计分析。结果186例脓毒症患者中男性、年龄≥50岁、肺炎感染、脑膜炎感染、初中及以下的人群患病率较高,脓毒症患者患病与性别、年龄、感染疾病的种类、受教育程度有关。对186例脓毒症患者共分离出病原菌263株,其中阴性菌占比为(136/263)51.71%,阳性菌占比为(90/263)34.22%,真菌占比为(37/263)14.07%,其中分布最大的为葡萄球菌属,占所有病原菌的14.82%。APACHE-Ⅱ评分≥20分的脓毒症患者与APACHE-Ⅱ评分<20分的脓毒症患者相比,APTT、PT、TT延长,血小板计数、FDP显著上升,差异有统计学意义(P<0.05)。APACHE-Ⅱ评分≥20分的脓毒症患者与APACHE-Ⅱ评分<20分的脓毒症患者相比,D-dimer表达差异无统计学意义(P>0.05)。血小板计数、FDP、TT、APTT、PT等凝血指标和脓毒症的病情严重程度(APACHE-Ⅱ评分)明显相关;D-dimer指标和脓毒症严重程度(APACHE-Ⅱ评分)无明显的相关性。性别、大年龄、感染疾病的种类、受教育程度低等因素均为脓毒症的主要患病危险因素。结论男性、年龄、感染特定疾病的种类、受教育程度低等为脓毒症的主要患病因素,且病原菌分布最多的为葡萄球菌属,对脓毒症早期诊治具有重要意义。

Objective To study the distribution of pathogenic bacteria in sepsis patients and related epidemiological investigation.Methods 186 patients with sepsis who were treated in the First Affiliated Hospital of Huzhou Normal University from September 2016 to September 2018 were selected as the subjects of study.The basic personal data of the patients were collected by means of questionnaires,including gender,age,types of infectious diseases and educational level.Under aseptic conditions,blood culture samples and wounds were collected.Bacterial culture was carried out to isolate,identify and distribute pathogenic bacteria in exudates,secretions of respiratory tract,substances at the tip of catheter and urine.The differences of platelet,D-Ddimer,fibrinolytic products(FDP),prothrombin time(PT),TT,partial thromboplastin time(APTT)and pus in patients were compared.The relationship between severity of sepsis(APACHE-Ⅱscore)was analyzed,and the correlation between related factors and incidence of sepsis was analyzed.Results Among 186 sepsis patients,male,aged over 50,pneumonia infection,meningitis infection,junior high school and below had a higher prevalence rate.The prevalence of sepsis patients was related to gender,age,types of infectious diseases and education level.A total of 263 pathogenic bacteria were isolated from 186 patients with sepsis.Among them,51.71%were negative bacteria(136/263),34.22%were positive bacteria(90/263),14.07%were fungi(37/263).Staphylococcus aureus was the most widely distributed pathogen,accounting for 14.82%of all pathogenic bacteria.Compared with sepsis patients with APACHE-Ⅱscore(>20),APTT,PT,TT prolonged,platelet count and FDP increased significantly in sepsis patients with APACHE-Ⅱscore(<20),and the difference was statistically significant(P<0.05).There was no significant difference in D-dimer expression between sepsis patients with APACHE-Ⅱscore(>20)and sepsis patients with APACHE-Ⅱscore(<20)(P>0.05).Platelet count,FDP,TT,APTT,PT and other coagulation indicators were significantly correlated with the severity of sepsis(APACHE-Ⅱscore);D-dimer indicators were not significantly correlated with the severity of sepsis(APACHE-Ⅱscore).Gender,age,types of infectious diseases and educational level are the main risk factors for sepsis.Conclusions Sex,age,types of infectious diseases and educational level are the main factors of sepsis,and the most pathogenic bacteria are Staphylococcus,which is of great significance for early diagnosis and treatment of sepsis.