CAJ | 학술논문

了解引起血流感染(BSI)病原菌的临床分布特征及耐药性,为指导临床合理用药提供依据。方法用BacT/ALERT 3D微生物全自动检测系统对血进行培养检测。用VITEK-2全自动微生物鉴定仪对病原菌进行鉴定及药物敏感性检测。以Whonet 5.4软件进行数据统计分析,通过查阅病历了解住院患者的临床资料。结果 2006至2009年中山大学孙逸仙纪念医院共收检血培养标本10462份,检出病原菌830株,阳性率为7.9％,其中革兰阴性杆菌442株,占53.3％(442/830),以大肠埃希菌为主,占33.7％(149/442);革兰阳性球菌275株占33.2％(275/830),以凝固酶阴性葡萄球菌(CoNS)为主,占44.4％(122/275);真菌113株,占13.6％(113/830),以热带念珠菌为主,占24.8％(28/113)。引起BSI的病原菌中,大肠埃希菌居首位(18.0％),其次为凝固酶阴性葡萄球菌(14.7％)、肺炎克雷伯菌(8.2％)。产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌分别为67.5％和49.1％。碳青酶烯类及阿米卡星对肠杆菌科细菌有较好的抗菌活性,左氧氟沙星对常见非发酵菌的体外抗菌活性较好。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为53.2％和88.5％,未发现耐万古霉素革兰阳性球菌。血流感染患者临床分布以ICU、儿科和血液科为主,分别为25.5％、22.2％和12.4％,其基础疾病以恶性肿瘤、血液病多见,分别为26.8％、20.6％。结论该院血流感染病原菌主要为大肠埃希菌,其次是凝固酶阴性葡萄球菌和肺炎克雷伯菌。万古霉素、替考拉宁、利奈唑烷及奎奴普丁或达福普汀对革兰阳性球菌有较好的抗菌活性;碳青酶烯类及左氧氟沙星对革兰阴性杆菌有较好的抗菌活性。有恶性肿瘤、血液病等基础疾病者易发生血流感染。
료해인기혈류감염(BSI)병원균적림상분포특정급내약성,위지도림상합리용약제공의거。방법 용BacT/ALERT 3D미생물전자동검측계통대혈진행배양검측。용VITEK-2전자동미생물감정의대병원균진행감정급약물민감성검측。이Whonet 5.4연건진행수거통계분석,통과사열병력료해주원환자적림상자료。결과 2006지2009년중산대학손일선기념의원공수검혈배양표본10462빈,검출병원균830주,양성솔위7.9％,기중혁란음성간균442주,점53.3％(442/830),이대장애희균위주,점33.7％(149/442);혁란양성구균275주점33.2％(275/830),이응고매음성포도구균(CoNS)위주,점44.4％(122/275);진균113주,점13.6％(113/830),이열대념주균위주,점24.8％(28/113)。인기BSI적병원균중,대장애희균거수위(18.0％),기차위응고매음성포도구균(14.7％)、폐염극뢰백균(8.2％)。산초엄보β-내선알매대장애희균화폐염극뢰백균분별위67.5％화49.1％。탄청매희류급아미잡성대장간균과세균유교호적항균활성,좌양불사성대상견비발효균적체외항균활성교호。내갑양서림금황색포도구균화내갑양서림응고매음성포도구균적검출솔분별위53.2％화88.5％,미발현내만고매소혁란양성구균。혈류감염환자림상분포이ICU、인과화혈액과위주,분별위25.5％、22.2％화12.4％,기기출질병이악성종류、혈액병다견,분별위26.8％、20.6％。결론 해원혈류감염병원균주요위대장애희균,기차시응고매음성포도구균화폐염극뢰백균。만고매소、체고랍저、리내서완급규노보정혹체복보정대혁란양성구균유교호적항균활성;탄청매희류급좌양불사성대혁란음성간균유교호적항균활성。유악성종류、혈액병등기출질병자역발생혈류감염。
Objective To investigate the clinical distribution and drug resistance of pathogens causing bloodstream infection (BSI) , and to guide reasonable use of antibiotics in clinical practices.Methods A BacT/ALERT 3D fully automatic microbe detection system was used for blood culture, and VITEK- 2 fully automatic system for pathogen identification and drug sensitivity test. The results were collected and analyzed using Whonet 5.4 software. Medical records were retrieved for clinical data of the patients during hospital stay. Results From 10 462 blood culture specimens collected in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from 2006 to 2009, 830 strains of pathogens (overall positive rate: 7.9％ ) were identified, including 442 strains (53.3％) of Gram - negative bacilli (GNB) with predominating E.coli [149/442, 33.7％], 275 strains (33.2％) of Gram-positive cocci with predominating coagulase-negative staphylococci (CoNS) [122/275, 44.4％], and 113 strains (13.6％) of fungi with predominating Caadida tropicalis [28/113, 24.8％]. The most common pathogens that caused BSI was E.coli (18.0％), followed by CoNS (14.7％) and Klebsiella pneumoniae (8.2％). ESBLs production was found in 67.5％ and 49.1％ of E.coli and Klebsiella pneumoniae strains respectively. Carbapenems and amikacin (AMK) showed favorable antibacterial activity against enterbacteriaceae, while levofloxacin (LVFX)showed favorable, in vitro antibacterial activity against common non-fermenters. The detection rate for MRSA and MRCoNS was 53.2％ and 88.5％ respectively. Vancomycin-resistance Gram positive cocci were not detected.ICU, departments of pediatrics and hematology were major sources of clinical distribution (25.5％, 22.2％and 12.4％ ). The underlying diseases in patients with bloodstream infections mainly included malignant tumor (26.8％) and hematopathy (20.6％). Conclusion In our hospital, the most common BSI-causing pathogens are E.coli, followed by CoNS and Klebsiella pneumonia. Vancomycin, teicoplanin, and quinupristin/dalfopristin show favorable antibacterial activity against Gram-positive cocci, as do carbapenems and LVFX against Gram-negative bacilli. Subjects with underlying malignant tumor or hematopathy are more likely to develop bloodstream infections.