血培养阳性老年脓毒症患者多重耐药菌分析

Analysis of multidrug-resistant organisms in elderly sepsis patients with positive blood culture

目的:分析血培养阳性老年脓毒症患者血标本的多重耐药菌(MDRO)分布特点和耐药性状况,为指导临床医师初始经验性抗菌药物的使用提供依据。方法:回顾性收集299例老年脓毒症患者的血培养结果,分析病原菌的分布、MDRO的药敏结果及耐药情况。结果:所有检出的病原菌中,革兰阴性菌占比51.17%,略高于革兰阳性菌(46.15%),真菌较少。其中,MDRO检出率为64.88%,排名前5位的分别是凝固酶阴性葡萄球菌(CNS)、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯杆菌、肠球菌属。耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、产超广谱β-内酰胺酶(ESBLs)细菌、耐碳青霉烯类肺炎克雷伯杆菌(CRKP)、耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐碳青霉烯类铜绿假单胞菌(CRPA)等6类临床常见的MDRO共检出93株,占所有MDRO的47.94%。药敏试验结果提示耐药严重,尤其是碳青霉烯耐药革兰阴性杆菌(CRO),包括CRKP、CRAB、CRPA等,几乎对所有抗菌药物耐药。结论:血培养阳性老年脓毒症患者的MDRO感染发生率高,且耐药性严重,迫切需要采取有效的防治措施来预防和控制耐药菌感染以及开发新的有效抗菌药物。

Objective:To analyze the distribution characteristics and drug resistance status of multidrug-resistant organisms(MDRO)in blood samples of elderly sepsis patients with positive blood culture,and to provide clinicians with guidance of initial empirical antibiotics therapy.Methods:The blood culture results from 299 elderly patients with sepsis were collected retrospectively,and the distribution of pathogenic bacteria,MDRO drug susceptibility results and drug resistance were retrospectively analyzed.Results:Among the detected pathogens,Gram-negative bacteria accounted for 51.17%,slightly more than Gram-positive bacteria(46.15%),and fungi were rare.Among them,the detection rate of MDRO was 64.88%,and the top 5 were coagulase-negative staphylococci(CNS),Escherichia coli,Staphylococcus aureus,Klebsiella pneumoniae,and Enterococcus.A total 93 strains clinically common MDRO of methicillin-resistant staphylococcus aureus(MRSA),vancomycin-resistant enterococci(VRE),extended-spectrumβ-lactamases(ESBLs)producing bacteria,carbapenem-resistant Klebsiella pneumoniae(CRKP),carbapenem-resistant acinetobacter baumannii(CRAB)and carbapenem-resistant pseudomonas aeruginosa(CRPA)accounted for 47.94%of all MDROs.The results of drug susceptibility tests showed severe drug resistance,especially carbapenem-resistant gram-negative organism(CRO),including CRKP,CRAB,PDR-PA,etc.,which were resistant to almost all antibacterial drugs.Conclusion:The incidence of multidrug-resistant organisms infection in elderly sepsis patients with positive blood culture is high,and the drug resistance is serious.It is urgent to take effective preventive measures to prevent and control the infection of drug-resistant organisms and to develop new effective antibacterial drugs.