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2016－2018年包头市某“三甲”医院患者血流感染病原学特点及临床特征分析
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| 篇名： | 2016－2018年包头市某“三甲”医院患者血流感染病原学特点及临床特征分析 |
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| 摘要： | 目的：分析内蒙古科技大学包头医学院第一附属医院患者血流感染病原学特点及临床特征，为临床抗感染治疗提供参考依据。方法：采用回顾性研究方法，对2016年1月1日－2018年12月31日我院6 052份血培养标本的阳性率进行统计，采用WHONET 5.6软件对送检科室、病原菌菌种分布和耐药性进行分析；对其中447例住院血流感染患者的性别、年龄、基础疾病、侵袭性操作、住院天数和预后（治愈、未治愈、死亡）等临床资料，按社区获得性血流感染（CABSI）和院内获得性血流感染（HABSI）进行分组，采用χ2检验分析两组患者上述临床资料的差异。结果：6 052份血培养样本中，总阳性率为10.3％（623/6 052）。血培养病原菌主要来源于感染疾病科12.0％（75/623）、肾内科11.4％（71/623）、血液内科10.8％（67/623）、普外科10.1％（63/623）等临床科室。623株病原菌中，革兰氏阴性菌占49.3％，革兰氏阳性菌占49.3％，真菌占1.4％；检出率居前6位的病原菌依次为凝固酶阴性葡萄球菌（36.5％）、大肠埃希菌（26.6％）、肺炎克雷伯菌（13.0％）、金黄色葡萄球菌（5.8％）、肠球菌属（5.8％）和铜绿假单胞菌（2.9％）。凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率为75.3％（171/227）；金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为25.0％（9/36）。葡萄球菌属对利福平的敏感率＞90.0％，肠球菌属对青霉素G、氨苄西林、高浓度庆大霉素、环丙沙星、左氧氟沙星、红霉素的耐药率均≥50.0％，未发现万古霉素耐药的革兰氏阳性菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株检出率分别为49.4％（82/166）和8.6％（7/81）；大肠埃希菌对碳青霉烯类抗菌药物的敏感率＞98.5％，肺炎克雷伯菌对碳青霉烯类抗菌药物的敏感率为100％，铜绿假单胞菌对碳青霉烯类抗菌药物的敏感率＞90.0％。447例住院血流感染患者中，CABSI占49.2％、HABSI占50.8％。HABSI组患者中基础疾病（包括糖尿病、恶性肿瘤、血液系统疾病、尿路感染、肝疾病、胆道疾病）、侵袭性操作、住院天数＞2周的患者比例和病死率均显著高于CABSI组（P＜0.05）。结论：我院血培养病原菌主要分布在感染疾病科等临床科室，其中以凝固酶阴性葡萄球菌和大肠埃希菌最为常见。HABSI好发于免疫功能受损的患者且预后差，临床应尽可能减少侵袭性操作，并合理选择抗菌药物进行抗感染治疗。 |
| ABSTRACT： | OBJECTIVE： To analyze the pathogenic characteristics and clinical features of patients with bloodstream infection in the First Affiliated Hospital of Baotou Medical College so as to provide reference for anti-infective treatment. METHODS： The positive rate of 6 052 blood culture specimens in our hospital collected during Jan 1st， 2016-Dec. 31st， 2018 were counted by retrospective study. WHONET 5.6 software was used to analyze clinical department， the distribution and drug resistance of pathogenic bacteria. The clinical data of 447 inpatients with bloodstream infection were collected in respect of gender， age， underlying disease， invasive operation， length of stay and prognosis （cured， uncured， dead）. The patients were divided into two groups according to community acquired blood flow infection （CABSI） and hospital acquired blood flow infection （HABSI）. The differences of the above clinical data between the two groups were analyzed by χ2 test. RESULTS： Total positive rate of 6 052 blood culture samples were 10.3％ （623/6 052）. The blood culture pathogens mainly came from infectious disease department （12.0％， 76/623）， nephrology department （11.4％， 71/623）， hematology department （10.8％， 67/623）， surgery department （10.1％， 63/623）. Of 623 strains of pathogens， Gram- negative bacteria accounted for 49.3％， Gram-positive bacteria accounted for 49.3％， and fungi accounted for 1.4％. The top six pathogens were Coagulase-negative Staphylococcus （36.5％）， E. coli （26.6％）， K. pneumoniae （13.0％）， S. aureus （5.8％）， Enterococcus （5.8％） and P. aeruginosa （2.9％）. The detection rate of MRCNS was 75.3％ in Coagulase-negative Staphylococcus （171/227） and that of MRSA was 25.0％ in S. aureus （9/36）， respectively. The sensitivity rate of Staphylococcus to rifampicin was higher than 90.0％， and the drug resistance rates of Enterococcus to penicillin G， ampicillin， high concentration of gentamicin， ciprofloxacin， levoflox acin and erythromycin were higher than or equal to 50.0％. No vancomycin-resistant gram positive bacteria were found. The prevalence of ESBLs-producing strains was 49.4％ in E. coli （82/166） and 8.6％ in K. pneumoniae （7/81）. The sensitivity of E. coli to carbapenems was higher than 98.5％. The sensitivity rate of K. pneumoniae to carbapenems was 100％. The sensitivity rate of P. aeruginosa to carbapenems was higher than 90.0％. Among 447 hospitalized BSI patients， CABSI accounted for 49.2％ and HABSI accounted for 50.8％. Distribution of underlying diseases （including diabetes mellitus， malignant tumor， hematological disease， urinary tract infection， liver disease， bitiary tract disease）， invasive operation， the proportion of patients with length of hospital stay＞2 weeks and death proportion were higher in HABSI group than CABSI group （P＜0.05）. CONCLUSIONS： The blood culture pathogens mainly came from infectious diseases department in our hospital. The most common pathogens were Coagulase negative Staphyococcus and E. coli. HABSI occurs more readily in immunocompromised patients and has a poor prognosis. Clinicians should reduce the use of invasive procedures and use appropriate antimicrobial agents for anti-infective treatment. |
| 期刊： | 2019年第30卷第21期 |
| 作者： | 李翠翠，张利霞，胡同平 |
| AUTHORS： | LI Cuicui，ZHANG Lixia，HU Tongping |
| 关键字： | 包头市；血流感染；病原菌；耐药性；临床特征 |
| KEYWORDS： | Baotou city； Bloodstream infection； Pathogens； Drug resistance； Clinical features |
| 阅读数： | 364 次 |
| 本月下载数： | 8 次 |
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