危重烧伤患者中心静脉导管相关感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria associated with central venous catheter-related infection in severe burn patients

目的探讨危重烧伤患者中心静脉导管(CVC)相关感染的病原菌分布及其耐药性,为预防和减少CVC相关感染提供依据。方法采用前瞻性研究方法。选择2018年1月至2021年12月在武汉大学同仁医院暨武汉市第三医院收治的符合入选标准的行CVC置管的危重烧伤患者148例。对CVC穿刺口根据有无创面行不同的护理。经正常皮肤置管处每7 d以5 g/L碘伏消毒穿刺点及周围皮肤,待干后贴上无菌3M透明敷贴覆盖导管。经创面置管处每天以5 g/L碘伏消毒穿刺点及周围皮肤,待干后用双层无菌纱布覆盖穿刺口,分泌物多时随时更换纱布。CVC拔管时行静脉导管尖端细菌半定量培养,并通过纸片扩散法对培养出的阳性菌株行药物敏感试验,观察病原菌种类及其耐药性。结果所有患者共行261例次置管,分离病原菌62株,其中革兰阴性菌41株,占66.13%;革兰阳性菌18株,占29.03%;真菌3株,占4.84%。排在前5位的病原菌分别是铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌与表皮葡萄球菌,分别占比为35.48%、19.35%、14.52%、8.06%、6.45%。铜绿假单胞菌对多黏菌素B耐药率为0,对头孢吡肟、哌拉西林耐药率均为75.00%以上,对其他抗菌药物均有不同程度的耐药。鲍曼不动杆菌对多黏菌素B耐药率为0,对除亚胺培南以外的9种抗菌药物耐药率均为100.00%;金黄色葡萄球菌对万古霉素、利奈唑胺及奎奴普丁/达福普汀耐药率均为0,对氨苄西林、青霉素耐药率均为100.00%,对其他抗菌药物均有严重耐药。结论危重烧伤患者CVC相关感染以革兰阴性菌为主,其中铜绿假单胞菌居首位,且耐药形式严峻,医务人员应引起重视,加强观察及护理,根据药物敏感试验结果合理应用抗菌药物,减少CVC相关感染的发生。

Objective To explore the distribution and drug resistance of pathogens bacteria associated with central venous catheter(CVC)-related infection in severe burn patients,so as to provide clinical basis for prevention and reduction of CVC-related infection.Methods A prospective study was conducted.From January 2018 to December 2021,148 patients with severe burn who met the inclusion criteria for CVC catheterization and hospitalized in Tongren Hospital of Wuhan University&Wuhan Third Hospital were recruited in the prospective study.Different nursing cares of patients were given to the CVC puncture site according to whether there was a wound or not.The puncture site and surrounding skin were disinfected with 5 g/L iodophor every 7 days at the place where the catheter was placed through normal skin.After drying,sterile 3M transparent application was applied to cover the catheter.The puncture site and surrounding skin were disinfected with 5 g/L iodophor every day at the wound catheterization site.After drying,the puncture site was covered with a double layer of sterile gauze,and the secretions were mostly changed when discharge was excessive.Semi-quantitative culture of bacteria at the tip of venous catheter was performed when CVC was decannulated.The drug sensitivity test was performed on the positive strains cultured by disk diffusion method to observe the species of pathogenic bacteria and their drug resistance.Results All patients underwent 261 catheterizations.A total of 62 strains of pathogenic bacteria were isolated from all patients,including 41 strains of Gram negative bacteria accounting for 66.13%,18 strains of Gram positive bacteria accounting for 29.03%,and 3 fungi accounting for 4.84%.The top five pathogens were Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae and Staphylococcus epidermidis,and accounting for 35.48%,19.35%,14.52%,8.06%and 6.45%respectively.The resistance rate of Pseudomonas aeruginosa to polymyxin B was 0,and were both more than 75.00%to cefepime and piperacillin,and it had different degrees of resistant to other antibiotics.The resistance rate of Acinetobacter baumannii to polymyxin B was 0,and to nine kinds of antibiotics except imipenem were all 100.00%.The resistance rates of Staphylococcus aureus to vancomycin,linezolid and quinuputin/dapfoptin were all 0,and to ampicillin and penicillin were all 100.00%.Staphylococcus aureus was severely resistant to other antibiotics.Conclusions Gram-negative bacteria are the main infections of CVC-related infection in sever burn patients,among which Pseudomonas aeruginosa is the first,and the drug resistance is severe.Medical staff should pay attention to it,strengthen observation and nursing,and rationally apply antibiotics according to the results of drug sensitivity test,so as to reduce the occurrence of CVC-related infections.