CAJ | 학술논문

目的了解儿科重症监护病房(PICU)血管内导管相关性血流感染(CRBSIs)的临床特点、病原菌分布及其耐药性,为合理使用抗生素提供依据.方法回顾性分析2009年9月至2014年9月在广东省人民医院PICU住院的CRBSIs患儿的临床特点、病原菌构成和药物敏感试验结果.结果 5年共使用中心静脉导管10 834 d,发生CRBSIs 23例,发病率为2.1/1 000导管日.置管时间＜7d9例(占39.1％),8～14 d 10例(占43.5％),14～21 d 4例(占17.4％).革兰阳性菌13例(占56.6％),革兰阴性菌5例(占21.7％),真菌5例(占21.7％).引起CRBSIs的主要病原菌依次为凝固酶阴性葡萄球菌(7株,占30.4％)、金黄色葡萄球菌(3株,占13.0％)、白色念珠菌(3株,占13.0％)、近平滑念珠菌(2株,占8.7％)、阴沟肠杆菌(2株,占8.7％).表皮葡萄球菌等凝固酶阴性葡萄球菌未发现万古霉素、利奈唑胺、替考拉宁耐药菌株;革兰阴性杆菌对亚胺培南、哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、阿米卡星敏感率均为100％;白色念珠菌、近平滑念珠菌对两性霉素B、5-氟胞嘧啶、氟康唑、伏立康唑敏感率均为100.0％.21例(91.3％)曾用抗生素,2例(8.7％)未用.真菌感染者平均使用抗生素4.4种,细菌为1.4种.曾用1种的10例(43.5％),2种的4例(17.4％),3种的4例(17.4％),3种以上的5例(21.7％).痊愈22例(95.7％),死亡1例(4.3％).结论 PICU内CRBSIs病原菌以凝固酶阴性葡萄球菌为主,延长导管留置时间且频繁使用多种抗生素者,需警惕真菌感染.规范使用抗菌药物,缩短置管时间是预防CRBSIs的有效措施,监测CRBSIs病原菌分布和药敏变迁有助于早期经验性用药.
목적 료해인과중증감호병방(PICU)혈관내도관상관성혈류감염(CRBSIs)적림상특점、병원균분포급기내약성,위합리사용항생소제공의거.방법 회고성분석2009년9월지2014년9월재광동성인민의원PICU주원적CRBSIs환인적림상특점、병원균구성화약물민감시험결과.결과 5년공사용중심정맥도관10 834 d,발생CRBSIs 23례,발병솔위2.1/1 000도관일.치관시간＜7d9례(점39.1％),8～14 d 10례(점43.5％),14～21 d 4례(점17.4％).혁란양성균13례(점56.6％),혁란음성균5례(점21.7％),진균5례(점21.7％).인기CRBSIs적주요병원균의차위응고매음성포도구균(7주,점30.4％)、금황색포도구균(3주,점13.0％)、백색념주균(3주,점13.0％)、근평활념주균(2주,점8.7％)、음구장간균(2주,점8.7％).표피포도구균등응고매음성포도구균미발현만고매소、리내서알、체고랍저내약균주;혁란음성간균대아알배남、고랍서림/삼서파탄、두포고동/서파탄、아미잡성민감솔균위100％;백색념주균、근평활념주균대량성매소B、5-불포밀정、불강서、복립강서민감솔균위100.0％.21례(91.3％)증용항생소,2례(8.7％)미용.진균감염자평균사용항생소4.4충,세균위1.4충.증용1충적10례(43.5％),2충적4례(17.4％),3충적4례(17.4％),3충이상적5례(21.7％).전유22례(95.7％),사망1례(4.3％).결론 PICU내CRBSIs병원균이응고매음성포도구균위주,연장도관류치시간차빈번사용다충항생소자,수경척진균감염.규범사용항균약물,축단치관시간시예방CRBSIs적유효조시,감측CRBSIs병원균분포화약민변천유조우조기경험성용약.
Objective To investigate the clinical characteristics,distribution and drug sensitivity of pathogens causing intravenous catheter-related bloodstream infections (CRBSIs) in pediatric intensive care unit (PICU) so as to use antibiotics reasonably.Methods All patients with CRBSIs in PICU of Guangdong General Hospital from September 2009 to September 2014 were investigated and the drug resistance profiles of pathogens causing CRBSIs were also analyzed retrospectively.Results Between 2009 and 2014,there were totally 10 834 catheter days and 23 episodes of CRBSIs with an incidence of 2.1 infections per 1 000 catheter days.Catheter indwell time ＜ 7 days in 9 cases (39.1％),8 to 14 days in 10 cases (43.5％),14 to 21 days in 4 cases (17.4％).There were 13 strains (56.6％) of gram-positive bacteria,5 strains (21.7％) of gram-negative bacteria and 5 strains (21.7％) of fungi.The main pathogens causing CRBSIs were coagulase negative Staphylococci (7 strains,30.4％),Staphylococcus aureus (3 strains,13.0％),Candida albicans(3 strains,13.0％),Candida parapsilosis(2 strains,8.7％),and Enterobacter cloacae (2 strains,8.7 ％).The susceptibility to Vancomycin,Linezolid and Teicoplanin of coagulase negative Staphylococ cus such as S.epidermidis and to Imipenem,Piperacillin/Tazobactam,Cefoperazone/ Sulbactam and Amikacin of gram-positive bacteria arrived at 100.0％,respectively.The candida were 100％ susceptible to Amphotericin B,5-Flucytosine,Fluconazole and Voriconazole.Twenty-one cases (91.3％) received antibiotic treatment versus no antibiotic in 2 cases (8.7％).The average number of antibiotic kinds administered on the patients with fungal infection was 4.4,bacteria were 1.4.Ten cases (43.5％) treatment with 1 kind of antibiotic,4 cases (17.4％) with 2,4 cases (17.4％) with 3,5 cases (21.7％) with more than 3.Twenty-two cases (95.7％) cured and 1 case died (4.3％).Conclusions The major species of pathogen causing CRBSIs was coagulase negative staphylococci in PICU.It is critical for clinicians to guard against fungal infection because of prolonged catheter indwelling time and more antibiotics administered before indwelling catheter.It is effective way to prevent the CRBSIs by reasonably using antibiotics and shortening the time of catheter indwelling.Monitoring CRBSIs pathogenic bacteria distribution and drug susceptibility helps reasonable administration of antibiotics in the earlier time.