重症医学科中心静脉导管相关性血流感染病原菌分布及耐药性分析

DISTRIBUTION AND DRUG RESISTANCE OF PATHOGENS IN CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN CRITICAL CARE MEDICINE

目的 分析重症医学科中心静脉导管相关性血流感染(CRBSI)病原菌分布及抗生素敏感情况,为临床工作提供借鉴。方法 收集2019—2021年在青岛大学附属医院重症医学科治疗的59例CRBSI病人的病原菌培养及药物敏感试验结果,对病原菌分布及耐药性进行分析。结果 病原菌中革兰阴性菌43例,革兰阳性菌14例,热带假丝酵母菌2例。大肠埃希菌(16例)、肺炎克雷伯菌(14例)、金黄色葡萄球菌(7例)和铜绿假单胞菌(6例)占病原菌前4位。大肠埃希菌对头孢类抗生素敏感性低,肺炎克雷伯菌对头孢类抗生素和阿莫西林/克拉维酸敏感性较低,葡萄球菌对万古霉素、替加环素及利奈唑胺等敏感,热带假丝酵母菌对氟康唑等主要抗真菌药物敏感。与非耐药菌组相比,耐药菌组病人年龄更大,病情更重,有基础疾病者的比例更高,中心静脉导管留置时间、住院时间和抗菌药物使用时间更长。结论 CRBSI病原菌以革兰阴性菌为主,革兰阴性杆菌感染病人细菌耐药率高,病原菌为耐药菌的CRBSI病人感染相关危险因素较多。

Objective To investigate the distribution and antibiotic sensitivity of pathogens in central venous catheter-related bloodstream infection(CRBSI) in critical care medicine, and to provide guidance for clinical practice. Methods The results of pathogen culture and drug sensitivity test were collected from 59 patients with CRBSI who were treated in Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, from 2019 to 2021, and the distribution and antibiotic sensitivity of pathogens were analyzed. Results Of all 59 patients, 43 had Gram-negative bacteria, 14 had Gram-positive bacteria, and 2 had Candida tropicalis. The top four pathogens were Escherichia coli(16 patients), Klebsiella pneumoniae(14 patients), Staphylococcus aureus(7 patients), and Pseudomonas aeruginosa(6 patients). Escherichia coli showed low sensitivity to cephalosporins;Klebsiella pneumoniae showed relatively low sensitivity to cephalosporins and amoxicillin/clavulanic acid;Staphylococcus was sensitive to vancomycin, tigecycline, and linezolid;Candida tropicalis was sensitive to the main antifungal agents including fluco-nazole. Compared with the non-drug-resistant bacteria group, the drug-resistant bacteria group had an older age, severer conditions, a higher proportion of patients with underlying diseases, and longer central venous catheter indwelling time, length of hospital stay, and duration of use of antibacterial agents. Conclusion Gram-negative bacteria are the main pathogens in CRBSI, and patients infected with Gram-negative bacilli tend to have a high drug resistance rate. CRBSI patients with drug-resistant bacteria as pathogens have more risk factors associated with infection.