2017-2019年汕头地区部分成人血流感染临床特点及病原学分析

Clinical characteristics and etiological analysis of bloodstream infection in adults in Shantou from 2017 to 2019

目的分析汕头地区成人血流感染(loodstream infection,BSI)患者的临床特点、病原菌分布和耐药情况,为本地区临床正确使用抗菌药治疗BSI提供依据。方法选取汕头市中心医院2017年1月-2019年12月急诊和住院成人血培养阳性并确诊为BSI的患者,回顾性分析BSI患者的临床特点、病原菌分布及耐药性。结果共有成人BSI患者2 040例,其中男1 032例,女1 008例,年龄18~98岁,平均年龄(62.23±15.91)岁,其中60岁以上占61.13%。绝大多数患者存在1种或以上基础疾病,以2型糖尿病最为常见。总共分离出BSI非重复病原菌2 166株,其中,67例患者存在混合感染。病原菌分离数量最多的前3位科室依次为急诊科、血液科和肾内科。分离菌株中,革兰阴性菌1 397株,占64.50%,革兰阳性菌726株,占33.52%,真菌43株,占1.98%。居前8位病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、草绿色链球菌、鲍曼不动杆菌、肠球菌属和铜绿假单胞菌。有44.09%的大肠埃希菌和15.65%的肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs);耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)和金黄色葡萄球菌(MRSA)的检出率分别为72.53%和43.92%。大肠埃希菌和肺炎克雷伯菌对阿米卡星、头孢西丁、β-内酰胺类/β-内酰胺酶抑制剂复方制剂、替加环素和碳青霉烯类具有较高敏感性。鲍曼不动杆菌具有较严重的多重耐药性,而铜绿假单胞菌对多种抗菌药均具有较高的敏感性。未发现耐万古霉素的葡萄球菌和肠球菌属。草绿色链球菌对头孢曲松、喹诺酮类、万古霉素和利奈唑胺具有高度敏感性。结论本地区成人BSI以老年患者居多,绝大多数患者存在1种或以上基础疾病,病原菌以革兰阴性菌为主,不同病原菌耐药性不同,定期开展BSI病原学监测,可为临床正确使用抗菌药提供帮助。

Objective To analyze the clinical characteristics, pathogen distribution and drug resistance of adult blood stream infection(BSI) patients in Shantou, so as to provide guidance for the correct use of antibiotics in the treatment of BSI. Methods Patients with BSI were selected from emergency and hospitalized adults with positive blood culture in Shantou Central Hospital from January 2017 to December 2019. The clinical characteristics,pathogen distribution and drug resistance of patients with BSI were analyzed retrospectively. Results There were2 040 adult patients with BSI, including 1 032 males and 1 008 females, aged from 18 to 98 years, with an average age of(62.23±15.91) years, of which 61.13% were over 60 years old. Most patients had one or more underlying diseases, and type 2 diabetes was most common. A total of 2 166 strains of BSI non-repetitive pathogens were isolated, of which 67 patients had mixed infection. The top three departments with the largest number of pathogens were the emergency department, the hematology department and the nephrology department. Among the isolated strains, there were 1 397 Gram-negative bacteria, accounting for 64.50%, 726 Gram-positive bacteria, accounting for 33.52%, and 43 fungi, accounting for 1.98%. The top 8 pathogens were Escherichia coli, coagulase negative Staphylococcus, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus viridans, Acinetobacter baumannii,Enterococcus and Pseudomonas aeruginosa. 44.09% of E. coli and 15.65% of K. pneumoniae produced extended spectrum β-lactamases(ESBLs). The detection rates of methicillin-resistant coagulase negative Staphylococcus(MRCNS) and S. aureus(MRSA) were 72.53% and 43.92%, respectively. Effects of E. coli and K. pneumoniae on amikacin, cefoxitin β-lactams/β-lactamase inhibitors compound preparations, tegacyclin and carbapenems had high sensitivity. A. baumannii had serious multiple drug resistance, while P. aeruginosa had high sensitivity to a variety of antibiotics. No vancomycin resistant Staphylococcus and Enterococcus were found. S. viridans was highly sensitive to ceftriaxone, quinolones, vancomycin and linezolid. Conclusion The majority of adult BSI patients in this region are elderly patients. The vast majority of patients have one or more basic diseases. The pathogens are mainly Gram-negative bacteria, and the drug resistance of different pathogens is different. Regular BSI etiological monitoring can provide help for the rational use of antibiotics in clinic.