医院获得性多菌血流感染病原菌分布及耐药特征分析

An analysis of pathogen distribution and drug resistance characteristics of hospital-acquired multibacteria bloodstream infection

目的分析医院获得性多菌血流感染病原菌分布及耐药特征。方法医院获得性血流感染患者2692例,根据血流感染病原菌数量分为单菌感染组和多菌感染组,比较两组患者病原菌分布及耐药特征。结果多菌血流感染占医院获得性血流感染的5.9%(159/2692),单菌血流感染占94.1%(2533/2692)。多菌感染组中ICU、肝胆胰外科比例高于单菌感染组,血液科比例低于单菌感染组(P<0.05)。多菌血流感染主要以两种病原菌混合感染为主,占84.3%(134/159),最常见的病原菌组合为大肠埃希菌+肠球菌属(10.1%)。与单菌感染组比较,多菌感染组大肠埃希菌对氨苄西林、头孢唑林、头孢呋辛、头孢他啶、头孢曲松、氨曲南、庆大霉素的耐药率较低(P<0.05),肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢吡肟、头孢替坦、氨曲南、亚胺培南、美罗培南、阿米卡星、妥布霉素、环丙沙星、左旋氧氟沙星的耐药率较低(P<0.05),铜绿假单胞菌对哌拉西林、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟的耐药率较高(P<0.05),屎肠球菌对克林霉素的耐药率较低(P<0.05);两组粪肠球菌及鲍曼不动杆菌耐药率无统计学差异(P>0.05)。结论医院获得性多菌血流感染科室分布、病原菌分布及药敏结果与单菌血流感染存在一定差异,了解多菌血流感染病原菌谱及耐药性,有助于临床早期经验用药。

Objective To analyze the pathogen distribution and drug resistance characteristics of hospital-acquired multi-bacteria bloodstream infection.Methods According to the number of bloodstream infection pathogens, 2692 patients with hospital-acquired bloodstream infection were divided into groups of A(with multi-bacteria infection) and B(with single-bacteria infection).The pathogen distribution and drug resistance characteristics were analyzed.Results The multi-bacteria bloodstream infections accounted for 5.9%(159/2692) and single-bacteria bloodstream infections accounted for 94.1%(2533/2692).The composition ratio of ICU and hepatopancreatobiliary surgery was higher and that of hematology was lower in group A than those in the group B(P<0.05).The multi-bacterial bloodstream infection was mainly caused by the mixture of two pathogenic bacteria, which accounted for 84.3%(134/159).The most common combination of pathogenic bacteria was Escherichia coli+Enterococcus(10.1%). Compared to group B,the resistance rates of Escherichia coli to ampicillin, cefazolin, cefuroxime, ceftazidime, ceftriaxone, amtreonam and gentamicin were lower in group A,those of Klebsiella pneumoniae to piperacillin/tazobactam, cefepime, cefotetan, amtreonam, imipenem, meropenem, amikacin, tobramycin, ciprofloxacin and levofloxacin were lower, those of Pseudomonas aeruginosa to piperacillin, cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime and cefepime were higher, and the resistance rate of Enterococcus faecium to clindamycin was lower in group A(P<0.05).The resistance rate of Enterococcus faecalis and Acinetobacter baumannii was not significantly different between the two groups(P>0.05).Conclusion The department distribution, pathogen distribution and drug resistance characteristics of hospital-acquired multi-bacteria bloodstream infection are different from that of single-bacteria bloodstream infection. Understanding the pathogenic spectrum and drug resistance of multi-bacteria bloodstream infection is helpful for early clinical experience in drug use.