ICU患者中心静脉导管相关性血流感染病原菌分布及耐药性分析

目的了解舟山市普陀区人民医院重症监护室（ICU）中心静脉导管相关性血流感染（CRBSI）患者病原菌分布及其药敏特点,为临床预防诊疗提供依据。方法收集2010年1月至2013年12月间在ICU住院的CRBSI患者的中心静脉导管进行培养,用法国梅里埃VITEK-32细菌鉴定仪进行菌种鉴定,用K-B纸片法进行细菌药敏试验,并用WHONET 5.4软件对耐药数据进行统计分析。结果共分离出病原菌310株,革兰阴性杆菌占50.97%,前四位为鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,占比分别为14.19%、12.26%、9.35%和7.10%;革兰阳性球菌占41.61%,前三位为表皮葡萄球菌、金黄色葡萄球菌和溶血葡萄球菌,占比分别为18.06%、7.42%和6.77%;真菌占7.42%,以白假丝酵母菌为主。药敏结果显示,主要革兰阴性杆菌对阿米卡星、左氧氟沙星、妥布霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南耐药率较低,主要革兰阳性球菌对左氧氟沙星、利福平、呋喃妥因、替考拉宁、万古霉素和利奈唑胺耐药率较低。结论 CRBSI的中心静脉导管培养的病原菌种类分布广泛,部分病原菌对常用抗菌药物的耐药率较高。临床医护人员应规范操作,减少耐药株的产生。

Pathogenic bacteria distribution and drug resistance analysis of intensive care unit patients with central venous catheter related blood stream infection

Objective To explore the distribution and drug susceptibility of pathogenic bacteria from intensive care unit（ ICU） patients with central venous catheter related blood stream infection（ CRBSI）,so as to provide the basis for clinical diagnosis and treatment. Methods The central venous catheters of ICU patients with CRBSI from Jan.2010 to Dec. 2013 were collected for pathogen culture. The pathogenic bacteria were identified by VITEK-32,the bacterial susceptibility was tested by paper method（ K-B） and statistical analysis was done with WHONET 5. 4software. Results A total of 310 strains of pathogenic bacteria were isolated,including Gam-negative bacillus（ 50.97%）; the top four pathogens were Acinetobacter baumannii（ 14.19%）,Pseudomonas aeruginosa（ 12.26%）,Eschericha coli（ 9.35%） and Klebsiella pneumoniae（ 7.10%）. Gram-positive cocci accounted for41. 61%; the top three pathogens were Staphylococcus epidermidis（ 18. 06%）,Staphylococcus aurelus（ 7. 42%）and Staphylococcus hemolytic（ 6. 77%）. Fungi accounted for 7. 42%. The Gram-negative bacilli were sensitive to Amikacin,Levofloxacin, Tobramycin, Piperacillin /tazobacta, Cefoperazone /sulbactam and Imipenem, while Gram-positive cocci were sensitive to Levofloxacin,Rifampicin,Nitrofurantoin,Teicoplanin,Rinathiazoleamine and Vancomycin. Conclusion CRBSI pathogenic bacteria are widely distributed,some of which are highly resistant to commonly used antimicrobial agents. Clinical operation should be regulated to reduce the generation of drugresistant strains.