维持性血液透析病人多重耐药菌感染特点分析

Analysis of characteristics of multi-drug resistant organism infection in patients with maintenance hemodialysis

目的探讨分析尿毒症病人维持性血液透析多重耐药菌感染所具有的特点、临床常见细菌谱及其耐药性,为临床血液透析病人的实际用药提供参考依据。方法收集2011-2016年期间贵州省人民医院肾内科收治的1 376名进行维持性血液透析病人资料,对其多重耐药菌感染的病原菌、分布及耐药性问题进行回顾性调查。结果在调查期间发生多重耐药菌感染的透析病人43例(3. 13%)、53例次,多重耐药菌感染病人标本中共分离多重耐药菌53株,其中革兰阳性球菌13株(25. 49%),以耐甲氧西林金黄色葡萄球菌为主;革兰阴性杆菌15株,以大肠埃希菌为主,大肠埃希菌感染多发生在呼吸道和泌尿道;鲍曼不动杆菌全部为呼吸道感染;耐甲氧西林金黄色葡萄球菌发生在血液感染和导管感染,说明多重耐药菌种感染发生部位具有偏好性。利奈唑胺和万古霉素对耐甲氧西林金黄色葡萄球菌耐药率最低;美洛培南对大肠埃希菌、产ESBL大肠埃希菌等多重耐药菌种具有显著的抗菌性。结论维持性血液透析病人为多重耐药菌的高发人群,多重耐药的革兰阴性杆菌为主要致病菌,耐甲氧西林金黄色葡萄球菌及产ESBL阳性大肠埃希菌感染高发,应加强抗菌药物的合理应用,积极控制病原菌的耐药性。

Objective To explore the characteristics of the multidrug-resistant infections of maintenance hemodialysis patients in uremic patients,the common bacterial spectrum and drug resistance,and provide reference for the actual use of clinical hemodialysis patients. Methods A total of 1 376 patients undergoing maintenance hemodialysis were enrolled in the Department of Nephrology,Guizhou Provincial People’s Hospital from 2011 to 2016. The pathogens,distribution and drug resistance of multi-drug resistant infections were retrospectively investigated. Results In the investigation,43 cases( 3. 13%) of dialysis patients with multi-drug resistant infection occurred,and 53 strains of multi-drug resistant bacteria were isolated from multi-drug resistant patients. Among them,13 strains of Gram-positive cocci( 25. 49%) were resistant to nails,mainly resistant to methicillin-resistant Staphylococcus aureus. There are 15 Gram-negative bacilli,mainly Escherichia coli,Escherichia coli infection mostly occurs in the respiratory tract and urinary tract;all of Acinetobacter baumannii are respiratory tract infection. Methicillin-resistant Staphylococcus aureus occurs in blood infections and catheter infections,indicating that there is a preference for sites of infection in multi-drug resistant strains. Linezolid and vancomycin have the lowest resistance rate to methicillin-resistant Staphylococcus aureus;meropenem has significant antibacterial activity against multi-drug resistant strains such as Escherichia coli and ESBL-producing Escherichia coli. Conclusion Maintenance hemodialysis patients are high-risk populations of multi-drug resistant bacteria,and the multi-drug resistant Gram-negative bacilli are the main pathogens. The incidence of Methicillin-resistant Staphylococcus aureus and ESBL-positive Escherichia coli infection was high. Rational application of antibacterial drugs should be strengthened to actively control the drug resistance of pathogenic bacteria.