中国感染与化疗杂志
中國感染與化療雜誌
중국감염여화료잡지
CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
2014年
3期
190-195
,共6页
邹颖%徐晓刚%郭庆兰%李光辉
鄒穎%徐曉剛%郭慶蘭%李光輝
추영%서효강%곽경란%리광휘
不动杆菌属%血流感染%多重耐药
不動桿菌屬%血流感染%多重耐藥
불동간균속%혈류감염%다중내약
Acinetobacter%bloodstream infection%multidrug-resistant
目的：研究多重耐药不动杆菌血流感染的菌种分布特点、临床特征、抗菌治疗及其与预后的关系。方法回顾性分析复旦大学附属华山医院2005年1月-2011年12月不动杆菌血流感染患者的临床及微生物学资料。结果74例不动杆菌血流感染患者入选，其中73例为医院感染，1例为社区获得性感染；原发性血流感染占51．4％（38/74）；继发性血流感染占48．6％（36/74），继发于肺部感染最常见，占23．0％（17/74）。基础疾病以实体肿瘤最多见，占24．3％（18/74），糖皮质激素应用、深静脉导管留置、手术及侵袭性操作是常见的诱发因素。发生血流感染后患者外周血白细胞总数及中性粒细胞比例较前升高，血清白蛋白水平下降，APACHE Ⅱ评分升高。74例血流感染患者中鲍曼不动杆菌感染65例，洛菲不动杆菌7例，琼氏不动杆菌1例，鲍曼不动杆菌和洛菲不动杆菌混合感染者1例；全因病死率为27．0％（20/74）。不动杆菌对头孢哌酮-舒巴坦耐药率最低，为20．0％（15/75），对碳青霉烯类抗生素耐药率为40．0％～42．7％。患者预后与不动杆菌对抗菌药物的敏感性相关。对碳青霉烯类和含舒巴坦制剂不敏感菌株感染患者的病死率分别为46．9％（15/32）和40．0％（12/30），显著高于敏感菌株感染患者的11．9％（5/42）和18．2％（8/44）。32例对碳青霉烯类不敏感菌株感染的患者中，20例接受了含舒巴坦制剂的抗菌药物，病死率为20．0％（4/20），明显低于未使用含舒巴坦制剂药物患者的66．7％（8/12）。结论不动杆菌血流感染绝大多数为医院感染，多发生于术后及重症患者。不动杆菌属对常用抗菌药物高度耐药，对碳青霉烯类和含舒巴坦制剂不敏感菌株感染患者病死率高，预后极差，应重视医院感染的防控。
目的：研究多重耐藥不動桿菌血流感染的菌種分佈特點、臨床特徵、抗菌治療及其與預後的關繫。方法迴顧性分析複旦大學附屬華山醫院2005年1月-2011年12月不動桿菌血流感染患者的臨床及微生物學資料。結果74例不動桿菌血流感染患者入選，其中73例為醫院感染，1例為社區穫得性感染；原髮性血流感染佔51．4％（38/74）；繼髮性血流感染佔48．6％（36/74），繼髮于肺部感染最常見，佔23．0％（17/74）。基礎疾病以實體腫瘤最多見，佔24．3％（18/74），糖皮質激素應用、深靜脈導管留置、手術及侵襲性操作是常見的誘髮因素。髮生血流感染後患者外週血白細胞總數及中性粒細胞比例較前升高，血清白蛋白水平下降，APACHE Ⅱ評分升高。74例血流感染患者中鮑曼不動桿菌感染65例，洛菲不動桿菌7例，瓊氏不動桿菌1例，鮑曼不動桿菌和洛菲不動桿菌混閤感染者1例；全因病死率為27．0％（20/74）。不動桿菌對頭孢哌酮-舒巴坦耐藥率最低，為20．0％（15/75），對碳青黴烯類抗生素耐藥率為40．0％～42．7％。患者預後與不動桿菌對抗菌藥物的敏感性相關。對碳青黴烯類和含舒巴坦製劑不敏感菌株感染患者的病死率分彆為46．9％（15/32）和40．0％（12/30），顯著高于敏感菌株感染患者的11．9％（5/42）和18．2％（8/44）。32例對碳青黴烯類不敏感菌株感染的患者中，20例接受瞭含舒巴坦製劑的抗菌藥物，病死率為20．0％（4/20），明顯低于未使用含舒巴坦製劑藥物患者的66．7％（8/12）。結論不動桿菌血流感染絕大多數為醫院感染，多髮生于術後及重癥患者。不動桿菌屬對常用抗菌藥物高度耐藥，對碳青黴烯類和含舒巴坦製劑不敏感菌株感染患者病死率高，預後極差，應重視醫院感染的防控。
목적：연구다중내약불동간균혈류감염적균충분포특점、림상특정、항균치료급기여예후적관계。방법회고성분석복단대학부속화산의원2005년1월-2011년12월불동간균혈류감염환자적림상급미생물학자료。결과74례불동간균혈류감염환자입선，기중73례위의원감염，1례위사구획득성감염；원발성혈류감염점51．4％（38/74）；계발성혈류감염점48．6％（36/74），계발우폐부감염최상견，점23．0％（17/74）。기출질병이실체종류최다견，점24．3％（18/74），당피질격소응용、심정맥도관류치、수술급침습성조작시상견적유발인소。발생혈류감염후환자외주혈백세포총수급중성립세포비례교전승고，혈청백단백수평하강，APACHE Ⅱ평분승고。74례혈류감염환자중포만불동간균감염65례，락비불동간균7례，경씨불동간균1례，포만불동간균화락비불동간균혼합감염자1례；전인병사솔위27．0％（20/74）。불동간균대두포고동-서파탄내약솔최저，위20．0％（15/75），대탄청매희류항생소내약솔위40．0％～42．7％。환자예후여불동간균대항균약물적민감성상관。대탄청매희류화함서파탄제제불민감균주감염환자적병사솔분별위46．9％（15/32）화40．0％（12/30），현저고우민감균주감염환자적11．9％（5/42）화18．2％（8/44）。32례대탄청매희류불민감균주감염적환자중，20례접수료함서파탄제제적항균약물，병사솔위20．0％（4/20），명현저우미사용함서파탄제제약물환자적66．7％（8/12）。결론불동간균혈류감염절대다수위의원감염，다발생우술후급중증환자。불동간균속대상용항균약물고도내약，대탄청매희류화함서파탄제제불민감균주감염환자병사솔고，예후겁차，응중시의원감염적방공。
Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible Acinetobacter (mortality 40.0% vs 18.2%,P <0.05).Of the 32 patients who had infections with carbapenem-non-susceptible Acinetobacter,20 received sulbactam-containing antimicrobial agent.The mor-tality of these 20 patients was 20.0% (4/20),significantly lower than that of the 12 patients who did not receive sulbactam-containing antimicrobial agent (66.7%).Conclusions Majority of the bloodstream infections caused by multidrug-resistant Acinetobacter are nosocomial infections.Surgical operation and serious condition may predispose the patients to develop Acine-tobacter bacteremia.Acinetobacter isolates are highly resistant to commonly used antibiotics.The Acinetobacter isolates not susceptible to carbapenem or cefoperazone-sulbactam are associated with poorer outcome and higher mortality.More attention should be paid to prevention and control of Acinetobacter-related nosocomial infections.
