先天性心脏病患者术后血流感染病原菌分布及耐药性分析

Distribution and Antibiotic Resistance of Pathogens from Blood Stream Infec⁃tions following Cardiac Surgery in Patients with Congenital Heart Disease

目的了解先天性心脏病(congenital heart disease,CHD)患者术后血流感染(blood stream infections,BSIs)病原菌分布及其耐药性,为合理选用抗菌素提供参考。方法回顾性分析2012年1月至2021年12月广东省人民医院CHD术后BSIs患者微生物学和药敏资料。结果76例患者共检出77株病原菌,其中革兰阳性(G+)菌44株(57.14%),革兰阴性(G-)菌25株(32.47%),真菌8株(10.39%);男女比例为1.81∶1,男49例(64.47%),女27例(35.53%);1~6个月龄59例(77.63%),7~12个月龄9例(11.84%),>1岁8例(10.53%),年龄中位数3.0(1.0~6.0)个月;简单型CHD 42例(55.26%),复杂型CHD34例(44.74%);术后<7 d发生BSIs 37例(48.68%),7~14 d 22例(28.95%),>14 d 17例(22.37%);主要病原菌为凝固酶阴性葡萄球菌(coagulase negative Staphylococci,CoNS)(24株,31.17%)、金黄色葡萄球菌(Staphylococcus aureus,SA)(11株,14.29%)、肺炎克雷伯菌(Klebsiella pneumoniae,KPN)(11株,14.29%)、鲍曼氏不动杆菌(4株,5.19%)、粪肠球菌(4株,5.19%)、白色念珠菌(3株,3.90%)和产气肠杆菌(3株,3.90%);其中简单型CHD以CoNS及SA为主,复杂型CHD以CoNS、KPN为主;革兰阳性菌以Co NS为主,万古霉素100%敏感;革兰阴性菌以KPN为主,产超广谱β-内酰胺酶(extended-spectrumβ-lactamase,ESBLs)占63.64%,碳青霉烯类抗生素敏感率最高,真菌主要为白色念珠菌,氟康唑、两性霉素B、5-氟胞嘧啶、伏立康唑、伊曲康唑100%敏感。存活出院74例(97.37%),院内死亡2例(2.63%)。结论CHD术后BSIs主要病原菌为CoNS、KPN和白色念珠菌;近10年,耐甲氧西林的(methicillin-resistant,MR)CoNS、MRSA对万古霉素保持高度敏感,ESBLs-KPN对碳青霉烯类抗生素敏感性有下降趋势;糖肽类、碳青霉烯类抗生素和三唑类抗真菌药物分别为革兰阳性菌、革兰阴性菌和真菌BSIs经验治疗的首选。

Objectives To investigate the distribution and drug sensitivity of pathogens causing blood stream infections(BSIs)after cardiac surgery in patients with congenital heart disease(CHD),so as to provide reference for rational selection of antibiotics.Methods The microbiological data and drug sensitivity profiles of the patients with BSIs after cardiac surgery with CHD in Guangdong Provincial People′s Hospital from January 2012 to December 2021 were investi⁃gated retrospectively.Results Totally 77 strains of pathogens were isolated from blood specimens of 76 patients with BSIs,of which 44 strains(57.14%)were gram-positive(G+)bacteria,25 strains(32.47%)were gram-negative(G-)bacteria and 8 strains(10.39%)were fungi.The male to female ratio was 1.81∶1,with 49 male(64.47%)and 27 female(35.53%).There were 59 patients aged 1-6 months(77.63%),9 patients aged 7-12 months(11.84%)and 8 patients aged>1 year(10.53%),while the mean age was 3.0(1.0-6.0)months.Of 76 patients,42 cases suffered from simple CHD(55.26%),34 cases with complex CHD(44.74%).Postoperative BSIs occurred within 7 days in 37 cases(48.68%),7 to 14 days in 22 cases(28.95%),and after 14 days in 17 cases(22.37%).The main pathogens causing BSIs were Coagulase-negative Staphylococci(CoNS)(24 strains,31.17%),Staphylococcus aureus(SA)(11 strains,14.29%),Klebsiella pneumoniae(KPN)(11 strains,14.29%),acinetobacter baumanii(4 strains,5.19%),enterococcus faecalis(4 strains,5.19%),candida albicans(3 strains,3.90%)and enterobacter aerogenes(3 strains,3.90%).The main pathogens of simple CHD were CoNS and SA,while the main pathogens of complex CHD were CoNS and KPN.Gram-positive bacteria were mainly CoNS,of which the sensitivity rate to vancomycin was 100.00%.Gram-negative bacteria were mainly KPN,63.64%of which were extended-spectrumβ-lactamase(ESBLs)and had the highest sensitivity rate to carbapenems.Candida albican was predominant pathogenic fungi,which was sensitive to fluconazole,amphotericin B,5-fluorocytosine,voriconazole and itraconazole.Seventy-four cases(97.37%)were discharged alive,and 2 cases(2.63%)died in hospital.Conclusions The main pathogens causing BSIs are CoNS,KPN and candida albican.In recent 10 years,the sensitivity of methicillin-resistant(MR)CoNS and MRSA to vancomycin remained stable,while the sensitivity of ESBLs-KPN to carbapenems declined.Glycopeptide antibiotics are recommended to treat grampositive bacteria BSIs,carbapenems are recommended to treat gram-negative bacteria BSIs,while triazole antifungal drugs are recommended to treat fungi BSIs.