Analysis of the distribution characteristics and drug resistance of pathogenic bacteria of blood infection
-
摘要:
目的 对血流感染病原菌分布特征以及常见细菌耐药态势进行回顾性分析，以期为临床诊疗血流感染提供参考与支撑。 方法 将马鞍山十七冶医院2016年7月—2019年7月门诊及住院患者血培养阳性标本纳入研究，将同一患者的重复菌株剔除，将已确认的污染菌剔除，依据统一方案分离血流感染病原菌，对血培养标本进行培养鉴定与药敏分析。 结果 经统计，收集非重复性病原菌合计708份，其中包含革兰阳性菌326株，占比为46.05%，革兰阴性菌373株，占比为52.68%，真菌9株，占比为1.27%。前5种病原菌依次为：凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌及铜绿假单胞菌。药敏分析结果显示，葡萄球菌和肠球菌对万古霉素、利奈唑胺、替考拉宁100%敏感，对红霉素耐药率>70%；产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的检出率分别为47.02%和30.15%，对头孢曲松、头孢他啶的耐药率为30%~50%，铜绿假单胞菌对测试的抗菌药物耐药率均 < 30%，所有分离的革兰阴性菌对碳青霉烯类抗菌药物耐药率 < 5%。 结论 血培养分离得到的病原菌菌谱广，耐药差异显著，临床医生应及早形成血培养检测意识，加强对血培养病原菌分布以及抗菌药物敏感性的监测，对患者施以“因人而异”的个体化诊疗方案，根据药敏结果合理使用抗菌药物，加强监测耐药态势变化，亟待指导临床合理用药，有效控制血流感染耐药菌的产生和传播。 Abstract:Objective To provide reference and support for clinical diagnosis and treatment of bloodstream infections, a retrospective analysis was performed to determine the distribution characteristics of pathogens of bloodstream infections and the drug resistance of common bacteria. Methods The positive blood culture specimens of outpatients and inpatients in our hospital from July 2018 to July 2019 were included in the study. Duplicate strains of the same patient were eliminated, as these confirmed that the contaminating bacteria were eliminated. The pathogen of bloodstream infection was isolated according to the unified program, and the blood culture specimens were cultured, identified and analysed for drug sensitivity. Results According to statistics, 708 non-repetitive pathogenic bacteria were collected, including 326 Gram-positive bacteria (46.05%), 373 Gram-negative bacteria (52.68%) and 9 fungi (1.27%). The first five pathogens were coagulase-negative Staphylococcus, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa. The results of drug sensitivity analysis showed that Staphylococcus and Enterococcus were 100% sensitive to vancomycin, linezolid and teicoplanin, and their drug resistance rates to erythromycin were higher than 70%. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamase were 47.02% and 30.15%, respectively. The drug resistance rates to ceftriaxone and ceftazidime were 30%-50%. The resistance rates of Pseudomonas aeruginosa to tested antibiotics were less than 30%, and the resistance rates of all isolated Gram-negative bacteria to carbapenems were less than 5%. Conclusion Blood culture pathogens isolated from the bacteria spectrum are many and varied. Considering the significant resistance of these pathogens to some drugs, clinicians should promote blood culture consciousness and strengthen the monitoring of blood culture pathogen distribution and antimicrobial sensitivity as soon as possible. Diagnosis and treatment of patients need to be individualized as they vary from person to person and should be performed in accordance with the rational use of antimicrobial agents in consideration of pathogen susceptibility. Clinicians need to strengthen the detection of drug resistance situation and changes thereof to guide clinical rational drug use, effective control of blood flow to the emergence and spread of drug-resistant bacterial infection. -
Key words:
- Bloodstream infection /
- Pathogenic bacteria /
- Resistance analysis
-
表 1 血流感染病原菌分布及构成比
病原菌名称 菌株数量(株) 构成比(%) 革兰阴性菌 373 52.68 大肠埃希菌 185 26.13 肺炎克雷伯菌 136 19.21 铜绿假单胞菌 23 3.25 阴沟肠杆菌 21 2.97 其他 8 1.13 革兰阳性菌 326 46.05 凝固酶阴性葡萄球菌 218 30.79 金黄色葡萄球菌 77 10.88 屎肠球菌 14 1.98 肠球菌属 12 1.69 其他 5 0.71 真菌 9 1.27 合计 708 100.00 
下载: 导出CSV
表 2 主要革兰阴性菌对常用抗菌药物的耐药率(%)
抗菌药物 大肠埃希菌(185株) 肺炎克雷伯菌(136株) 铜绿假单胞菌(23株) 阴沟肠杆菌(21株) 氨卞西林 87.12 - - - 哌拉西林 76.61 41.38 6.74 26.31 哌拉西林/他唑巴坦 0.83 5.51 7.14 0.00 头孢他啶 47.14 31.64 7.32 14.63 头孢吡肟 22.15 23.70 7.85 0.00 头孢曲松 48.56 35.64 - 23.11 厄他培南 0.00 4.41 - 0.00 亚胺培南 0.00 3.68 4.35 0.00 环丙沙星 54.36 27.59 28.57 22.22 庆大霉素 22.15 23.88 7.53 0.00 左氧氟沙星 56.22 21.28 29.75 9.52 阿米卡星 1.34 5.51 6.52 0.00 四环素 67.96 51.24 - 9.34 注：“-”表示该细菌对该抗生素天然耐药或CLSI无相应折点。
下载: 导出CSV
表 3 主要革兰阳性菌对常用抗菌药物的耐药率(%)
抗菌药物 凝固酶阴性葡萄球菌(218株) 金黄色葡萄球菌(77株) 屎肠球菌(14株) 氨卞西林/舒巴坦 81.75 12.23 - 苯唑西林 79.90 14.17 - 青霉素 91.25 96.07 0.00 利福平 3.87 7.69 29.41 利奈唑胺 0.00 0.00 0.00 红霉素 81.42 94.44 71.47 环丙沙星 38.28 11.78 41.92 庆大霉素 42.85 39.38 - 左旋氧氟沙星 6.44 3.14 27.62 万古霉素 0.00 0.00 0.00 替考拉宁 0.00 0.00 0.00 注：“-”表示该细菌对该抗生素天然耐药或CLSI无相应折点。
下载: 导出CSV
-
[1] 周梦兰, 杨启文, 于淑颖, 等. 血流感染流行病学研究进展[J]. 中国感染与化疗杂志, 2019, 19(2): 212-217. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201902021.htm [2] HUERTA L E, RICE T W. Pathologic difference between sepsis and bloodstream infections[J]. J Appl Lab Med, 2019, 3(4): 654-663. doi: 10.1373/jalm.2018.026245 [3] 韩如慧, 金美娟, 乔美珍, 等. 血液肿瘤患者经外周静脉置入中心静脉导管相关血流感染的影响因素分析[J]. 中国感染与化疗杂志, 2018, 18(2): 150-155. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201802008.htm [4] LAMY B, SUNDQVIST M, IDELEVICH E A, et al. Bloodstream infections-Standard and progress in pathogen diagnostics[J]. Clin Microbiol Infect, 2020, 26(2): 142-150. doi: 10.1016/j.cmi.2019.11.017 [5] 中华人民共和国国家卫生和计划生育委员会. WS/T503-2017临床微生物实验室血培养操作规范[S]. 2017. [6] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S]. 2019, M100-S29. [7] SAAD E J, BAENAS D F, BOISSEAU C S, et al. Characteristics of bloodstream infections in adult patients of two third level centers of Córdoba, Argentina[J]. Rev Fac Cien Med Univ Nac Cordoba, 2018, 75(3): 156-167. doi: 10.31053/1853.0605.v75.n3.19455 [8] 陈云波, 嵇金如, 应超群, 等. 2016至2017年全国血流感染细菌耐药监测(BRICS)报告[J]. 中华临床感染病杂志, 2020, 13(1): 42-43, 54. [9] 陈国敏, 王东辰, 许会彬, 等. 3889份住院患者血培养病原菌分布及耐药性分析[J]. 中国抗生素杂志, 2019, 44(2): 266-269. doi: 10.3969/j.issn.1001-8689.2019.02.021 [10] 菅记涌, 解泽强, 全秀秀, 等. 血流感染病原菌分布及耐药性分析[J]. 中华医院感染学杂志, 2017, 27(3): 535-538. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201703016.htm [11] 唐洪影, 胡志东, 李静, 等. 2014—2017年血培养常见病原菌的菌群分布及其耐药性变迁[J]. 中国抗生素杂志, 2018, 43(5): 566-571. doi: 10.3969/j.issn.1001-8689.2018.05.013 [12] 李保松, 纪冰, 安新业, 等. 2016—2017年滨州地区血流感染病原菌分布及其耐药性分析[J]. 滨州医学院学报, 2019, 42(6): 418-420, 423. https://www.cnki.com.cn/Article/CJFDTOTAL-BZYB201906006.htm [13] 伍婷婷, 曾吉, 景小鹏, 等. 血培养分离凝固酶阴性葡萄球菌的临床意义[J]. 中华传染病杂志, 2018, 36(11): 661-664. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL200102007.htm [14] ASAAD A M, ANSAR QURESHI M, MUJEEB HASAN S. Clinical significance of coagulase-negative staphylococci isolates from nosocomial bloodstream infections[J]. Infect Dis(Lond), 2016, 48(5): 356-360. doi: 10.3109/23744235.2015.1122833 [15] 刘兆玮, 马科, 胡景玉, 等. 重症监护病房血流感染的危险因素及预后分析[J]. 中国感染与化疗杂志, 2019, 19(1): 12-17. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201901004.htm [16] HATTORI H, MAEDA M, NAGATOMO Y, et al. Epidemiology and risk factors for mortality in bloodstream infections: A single-center retrospective study in Japan[J]. Am J Infect Control, 2018, 46(12): e75-e79. [17] 陈倩倩, 宋缘缘, 唐洪影, 等. 2015—2018年血流感染病原菌菌群分布及耐药性分析[J]. 天津医科大学学报, 2020, 26(3): 271-275. [18] CHEN C H, LIN L C, CHANG Y J. Clinical and microbiological characteristics of vancomycin-resistant Enterococcus faecium bloodstream infection in Central Taiwan[J]. Medicine(Baltimore), 2017, 96(49): e9000. [19] 叶小群, 杨青, 严平, 等. 耐万古霉素肠球菌血流感染相关因素分析[J]. 中华医院感染学杂志, 2018, 28(19): 2901-2904. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201819006.htm [20] 张志军, 鹿麟, 牛法霞, 等. 耐碳青霉烯类肺炎克雷伯菌的耐药机制与分子流行病学特征[J]. 中国感染控制杂志, 2018, 17(9): 759-763. https://www.cnki.com.cn/Article/CJFDTOTAL-GRKZ201809003.htm [21] 缪柯淳, 苏青青, 张新月, 等. 铜绿假单胞菌血流感染251例临床分析[J]. 中国感染与化疗杂志, 2018, 18(6): 568-573. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL201806002.htm -
点击查看大图
表(3)
计量
- 文章访问数: 161
- HTML全文浏览量: 47
- PDF下载量: 6
- 被引次数: 0
