发热伴血小板减少综合征患者多药耐药菌感染及其耐药性

Analysis of multi-drug resistant bacteria infection and its drug resistance in severe fever with thrombocytopenia syndrome patients

目的探究发热伴血小板减少综合征(SFTS)患者多药耐药菌感染的特点和耐药性。方法回顾性分析2011-2021年于中国人民解放军联勤保障部队第九九〇医院因SFTS住院患者细菌感染和耐药情况,并探究多药耐药菌感染对患者死亡结局的影响。结果共纳入718例SFTS患者,278例(38.7%)患者发生了细菌感染,其中105例合并多药耐药菌感染。共培养出385株细菌,革兰阴性菌为主(74.3%),其中肺炎克雷伯菌89株,铜绿假单胞菌47株;革兰阳性菌99株,其中金黄色葡萄球菌17株,溶血葡萄球菌17株。385株细菌中共有多药耐药菌129株(33.5%),其中肺炎克雷伯菌22株、大肠埃希菌16株。革兰阴性多药耐药菌对氨苄青霉素、氨苄青霉素/舒巴坦、庆大霉素和哌拉西林高度耐药,对比阿培南和亚胺培南敏感性较高;革兰阳性菌多药耐药菌对阿莫西林/克拉维酸、克林霉素、环丙沙星和头孢曲松完全耐药,且暂未发现敏感性较高的抗菌药物。多药耐药菌感染会增加SFTS患者的死亡风险(OR=1.736)。结论SFTS患者合并细菌感染的风险较高,多药耐药菌占比较高且对多种抗菌药物具有耐药性,合并多药耐药菌感染会增加SFTS患者的死亡风险。对SFTS患者应尽早进行微生物培养和药敏试验,合理选择抗菌药物治疗。

OBJECTIVE To investigate the characteristics and drug resistance of multiple drug-resistant bacteria co-infection in severe fever with thrombocytopenia syndrome(SFTS)patients.METHODS The results of bacterial detection and drug sensitivity test in SFTS patients hospitalized in the 990th Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army from 2011 to 2021 were retrospectively analyzed,and the effect of multi-drug resistant bacteria infection on the death outcome of SFTS patients were explored.RESULTS A total of 718 patients with SFTS were included in this study,278 patients(38.7%)developed bacterial infection,of whom 105 patients were complicated with multi-drug resistant bacteria infection.A total of 385 strains of bacteria cultured from 1278 samples were mainly gram-negative bacteria(74.3%),including 89 strains of Klebsiella pneumoniae and 47 strains of Pseudomonas aeruginosa.There were 99 strains of gram-positive bacteria,including 17 strains of Staphylococcus aureus and 17 strains of Staphylococcus haemolyticus.There were 129 strains(33.5%)of multidrug resistant bacteria in 385 strains,including 22 strains of K.pneumoniae and 16 strains of Escherichia coil.Gram-negative multi-drug resistant bacteria were highly resistant to ampicillin,ampicillin/sulbactam,gentamicin and piperacillin,and less resistant to compared with apenem and imipenem.Gram-positive multi-drug resistant bacteria were completely resistant to amoxicillin/clavulanic acid,clindamycin,ciprofloxacin and ceftriaxone,and not highly sensitive to any antibacterial drugs that were found so far.Multi-drug resistant bacteria co-infection increased the risk for fatal outcomes in SFTS patients(OR=1.736).CONCLUSION SFTS patients had a higher risk for bacterial co-infection.High proportion of multidrug-resistant bacteria,resistance to multiple antibiotics and multidrug-resistant bacteria co-infection significantly increased the risk of fatal outcomes.For SFTS patients,microbial culture and drug sensitivity test should be carried out as soon as possible,and antimicrobial therapy should be selected reasonably.