福建某三甲医院血流感染病原学分布及耐药分析

Etiological distribution and antibiotic resistance profile of bloodstream infections in a Fujian tertiary hospital

目的通过总结血流感染(BSI)的常见致病菌并分析其耐药情况,旨在早期为抗感染方案选择提供指向。方法对2015年1月—2020年12月福建省立医院确诊BSI病患83例的病原学及临床情况进行回顾性分析。结果83例患者纳入研究,致病微生物总计分离得到97株,其中革兰阴性菌54株(55.67%),革兰阳性菌31株(31.96%),真菌12株(12.37%),以大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、屎肠球菌最常见。其中65例(78.31%)来源于社区,以泌尿系感染为主;18例(21.68%)来源于院内,以皮肤感染为主。检出产超广谱β-内酰胺酶(ESBLs)肠杆菌10株(25.00%),耐碳青霉烯类肠杆菌(CRE)3株(7.50%),耐甲氧西林凝固酶阳性金黄色葡萄球菌(MRSA)3株(12.50%),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)5株(20.83%)。多重耐药菌(MDR)占50.00%,院内感染患者中MDR占比93.33%,全部来源于ICU。结论医院BSI主要为革兰阴性菌,社区来源多见,大肠埃希菌最常见,而院内感染患者致病菌主要为MDR。

Objective To investigate the etiological features and antibiotic resistance profile of bloodstream infections for early reasonable treatment.Methods Microbiological and clinical data were collected from confirmed bloodstream infections treated as inpatienets in Fujian Provincial Hospital from January 2015 to December 2020.Results A total of 97 nonduplicated pathogens were identified from 83 patients.Of the 97 pathogenic isolates,gram negative organisms were 54(55.67%),gram positive organisms were 31(31.96%),and fungal pathogens were 12(12.37%).The topic five pathogenic species were E.coli,K.pneumoniae,S.aureus,coagulase-negative Staphylococcus,Enterococcus faecalis.Community-acquired and nosocomial bloodstream infections were accounted for 78.31%(65/83),21.68%(18/83).The principal site of infections were in urinary infection,next were in skin infection.Carbapenem-resistant Enterobacter and A.baumannii were accounted for 7.50% and 2.50% the prevalence of MRSA and MRCNS were 12.50% and 20.83%.About 50.00% of the pathogens were multi-drug resistant,93.33% of patients with nosocomial infections were infected with multi-drug resistant,all of which isolated from ICU.Conclusion Nosocomial bloodstream infections are mainly gram-negative bacteria,which are more common from community sources,and Escherichia coli is the most common.The pathogenic bacteria in patients with nosocomial infection are mainly multi-drug resistant bacteria.