2013-2017年ICU脓毒症患者临床特征及病原菌学分析

Pathogenic bacteria and clinical characteristics of ICU patients with sepsis from 2013 to 2017

目的了解重庆市公共卫生医疗救治中心和重庆市九龙坡区人民医院的脓毒症患者临床特征、感染病原菌分布及耐药情况,为临床早期经验性用药提供依据。方法回顾性分析2013年1月至2017年12月重庆市公共卫生医疗救治中心和重庆市九龙坡区人民医院收治的共256例脓毒症患者送检样本检出病原菌分布及药敏结果,将所有患者按出院时的预后分为死亡组和存活组并对临床资料进行分析。结果共筛选得到256例符合诊断标准的脓毒症患者,从患者送检样本中共分离出268株病原菌,其中革兰阴性菌166株(61.9%),革兰阳性菌67株(25.0%),真菌35株(13.1%)。分离率前5位的病原菌为大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌和鲍曼不动杆菌。大肠埃希菌等肠杆菌科细菌对阿米卡星、头孢替坦及碳青霉烯类抗菌药物耐药率均低于10.0%,铜绿假单胞菌对除亚胺培南以外的大多数抗菌药物耐药率均在30.0%以下,鲍曼不动杆菌对大多数抗菌药物耐药率在87.0%以上,对头孢哌酮/舒巴坦耐药率为17.4%。金黄色葡萄球菌对万古霉素、利奈唑胺仍全部敏感,耐甲氧西林金黄色葡萄球菌(MRSA)检出率36.4%。临床资料分析,死亡组患者平均年龄、血乳酸及降钙素原水平均显著高于存活组,差异有统计学意义(P<0.05)。结论收治的脓毒症患者感染病原菌以革兰阴性菌为主,鲍曼不动杆菌多重耐药情况较为严重,临床应根据当地医院药敏监测情况合理用药。

Objective To investigate the clinical features,distribution and drug resistance of pathogenic bacteria isolated from patients with sepsis in the Chongqing Public Health Medical Center and Chongqing Jiulongpo District People′s Hospital,and to provide evidence for the clinical rational use of drug.Methods A retrospective analysis was made for the clinical features,distribution and antimicrobial susceptibility test of pathogens isolated from the sepsis patients(256 cases)in the two hospitals from January 2013 to December2017.Results A total of 256 patients with sepsis were screened,and totally 268 strains of pathogenic bacteria were isolated,including gram-negative bacteria 166 strains(61.9%),gram positive bacteria 67 strains(25.0%),fungus 35 strains(13.1%).The main pathogens were Escherichia coli,Pseudomonas aeruginosa,Staphylococcus aureus,Klebsiella pneumoniae and Acinetobacter baumannii.The drug resistance rate of Escherichia coli and Klebsiella pneumoniae to amikacin,cefotetan and Carbapenems antibiotics were lower than10.0%.The resistance of pseudomonas aeruginosa to most antibiotics other than imipenan were less than 30.0%,and the resistance of Acinetobacter baumannii to most antibacterial drugs were more than 87.0%,but to Cefoperazone/sulbatan was 17.4%.Staphylococcus aureus was still highly sensitive to vancomycin and linnazole,and the detection rate of methicillin-resistant staphylococcus aureus(MRSA)was 36.4%.The mean age,serum lactate and procalcitonin in the death group were significantly higher than those in the survival group,the difference was statistically significant(P<0.05).Conclusion Gram-negative bacteria are the main pathogen of ICU sepsis in the hospitals,and the resistance situation of Acinetobacter baumannii is serious.Clinical rational use of drugs should be taken according to the local drug sensitivity monitoring.