心血管内科患者医院感染病原菌类型及相关因素分析
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摘要
目的分析心血管内科患者医院感染的病原菌及相关因素,指导临床疾病治疗。方法选取2017-2018年本院收治的436例心血管内科患者临床资料,参照诊断标准并采用全自动微生物鉴定仪鉴定患者感染的病原菌类型。采用K-B法监测肺炎克雷伯菌耐药性,并采用统计学分析患者感染发生的相关因素。结果 436例心血管内科患者中,感染62例,感染率14.22%。分离57株病原菌,革兰阴性菌37株、革兰阳性菌17株、真菌3株。肺炎克雷伯菌、大肠埃希菌、其他革兰阴性菌、金黄色葡萄球菌、肺炎链球菌、其他革兰阳性菌、白色假丝酵母菌、光滑假丝酵母菌分别为24、8、5、11、4、2、2和1株,构成比分别为42.11%、14.04%、8.77%、19.30%、7.02%、3.51%、3.51%和1.75%。患者下呼吸道、上呼吸道、泌尿系、消化道、皮肤软组织、口腔部位感染菌株数分别为19、15、8、7、5和3株,构成比分别为33.33%、26.32%、14.04%、12.28%、8.77%和5.26%。痰液、血液、尿液、其他分泌物分离菌株分别为26、18、8和5株。肺炎克雷伯菌对头孢噻肟、头孢呋辛、环丙沙星、左氧氟沙星、亚胺培南的耐药率分别为37.50%、54.17%、29.17%、20.83%和8.33%。年龄、住院时间、合并症以及患者心功能级别为患者医院感染的相关因素。结论肺炎克雷伯菌是最主要病原菌,上呼吸道是好发部位,肺炎克雷伯菌对亚胺培南耐药率相对较低,临床应合理用药。年龄、住院时间、合并症以及患者心功能级别是感染发生相关因素,诊疗中应给予重视。
Objectives To analyze pathogen distribution and factors related to development of a nosocomial infection in patients in Cardiovascular Medicine in order to guide the clinical treatment of that condition. Methods Clinical data on 436 patients in Cardiovascular Medicine at this Hospital from 2017 to 2018 were collected, and pathogens infecting patients were identified with the help of an automated microbial identification system according to diagnostic criteria. The drug resistance of Klebsiella pneumoniae was determined using the K-B method, and the factors correlated with infection were statistically analyzed. Results Of 436 patients in Cardiovascular Medicine, 62 had a nosocomial infection for a rate of infection of 14.22%. A total of 57 strains of pathogens were isolated, including 37 strains of Gram-negative bacteria(64.91%), 17 strains of Gram-positive bacteria(29.82%), and 3 strains of fungi(5.26%). Of the 57 strains, 24(42.11%) were K. pneumoniae, 8(14.04%) were Escherichia coli, 5(8.77%) were other Gram-negative bacteria, 11(19.30%) were Staphylococcus aureus, 4(7.02%) were Streptococcus pneumoniae, 2(3.51%) were other Gram-positive bacteria, 2(3.51%) were Candida albicans, and 1(1.75%) was C. glabrata. Nineteen strains(33.33%) infected the lower respiratory tract, 15(26.32%) infected the upper respiratory tract, 8(14.04%) infected the urinary tract, 7(12.28%) infected the digestive tract, 5(8.77%) infected the skin or soft tissue, and 3(5.26%) infected the mouth. Twenty-six strains(45.61%) were isolated from sputum, 18(31.58%) were isolated from blood, 8(14.04%) were isolated from urine, and 5(8.77%) were isolated from other secretions. The resistance of K. pneumoniae to cefotaxime was 37.50%, its resistance to cefuroxime was 54.17%, its resistance to ciprofloxacin was 29.17%, its resistance to levofloxacin was 20.83%, and its resistance to imipenem was 8.33%. Age, duration of hospitalization, complications, and the level of cardiac function were all factors related to development of a nosocomial infection in patients in Cardiovascular Medicine. Conclusion K. pneumoniae is the main pathogen causing a nosocomial infection in patients in Cardiovascular Medicine. The upper respiratory tract is the main site of infection, and pathogens are mainly found in sputum specimens. K. pneumoniae had relatively low resistance to imipenem; this fact should be considered in order to use drugs rationally. Age, duration of hospitalization, complications, and the level of cardiac function were all factors related to the development of an infection. In clinical practice, attention should be paid to controlling the spread of pathogens and the incidence of infection.
Objectives To analyze pathogen distribution and factors related to development of a nosocomial infection in patients in Cardiovascular Medicine in order to guide the clinical treatment of that condition. Methods Clinical data on 436 patients in Cardiovascular Medicine at this Hospital from 2017 to 2018 were collected, and pathogens infecting patients were identified with the help of an automated microbial identification system according to diagnostic criteria. The drug resistance of Klebsiella pneumoniae was determined using the K-B method, and the factors correlated with infection were statistically analyzed. Results Of 436 patients in Cardiovascular Medicine, 62 had a nosocomial infection for a rate of infection of 14.22%. A total of 57 strains of pathogens were isolated, including 37 strains of Gram-negative bacteria(64.91%), 17 strains of Gram-positive bacteria(29.82%), and 3 strains of fungi(5.26%). Of the 57 strains, 24(42.11%) were K. pneumoniae, 8(14.04%) were Escherichia coli, 5(8.77%) were other Gram-negative bacteria, 11(19.30%) were Staphylococcus aureus, 4(7.02%) were Streptococcus pneumoniae, 2(3.51%) were other Gram-positive bacteria, 2(3.51%) were Candida albicans, and 1(1.75%) was C. glabrata. Nineteen strains(33.33%) infected the lower respiratory tract, 15(26.32%) infected the upper respiratory tract, 8(14.04%) infected the urinary tract, 7(12.28%) infected the digestive tract, 5(8.77%) infected the skin or soft tissue, and 3(5.26%) infected the mouth. Twenty-six strains(45.61%) were isolated from sputum, 18(31.58%) were isolated from blood, 8(14.04%) were isolated from urine, and 5(8.77%) were isolated from other secretions. The resistance of K. pneumoniae to cefotaxime was 37.50%, its resistance to cefuroxime was 54.17%, its resistance to ciprofloxacin was 29.17%, its resistance to levofloxacin was 20.83%, and its resistance to imipenem was 8.33%. Age, duration of hospitalization, complications, and the level of cardiac function were all factors related to development of a nosocomial infection in patients in Cardiovascular Medicine. Conclusion K. pneumoniae is the main pathogen causing a nosocomial infection in patients in Cardiovascular Medicine. The upper respiratory tract is the main site of infection, and pathogens are mainly found in sputum specimens. K. pneumoniae had relatively low resistance to imipenem; this fact should be considered in order to use drugs rationally. Age, duration of hospitalization, complications, and the level of cardiac function were all factors related to the development of an infection. In clinical practice, attention should be paid to controlling the spread of pathogens and the incidence of infection.
引文
[1] 黄家芹,刘静,刘薇.心血管内科患者感染的危险因素及预防对策[J].中华医院感染学杂志,2013,23(14):3345-6.
[2] 陈向东,曹淑贞,马军,等.慢性心力衰竭患者并发医院感染的临床分析[J].中华医院感染学杂志,2014,24(17):4269-71.
[3] Rello J,Ollendorf DA,Oster G,et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J].Chest,2002,122(6):2115-21.
[4] Pawar M,Mehta Y,Khurana P,et al.Ventilator-associated pneumonia:Incidence,risk factors,outcome,and microbiology[J].Cardiothorac Vasc Anesth,2003,17(1):22-8.
[5] Chan WH,Khin LW,Chung YF,et al.Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute pepticulcer bleeding[J].Br J Surg,2011,98(5):640-4.
[6] 周军,李清.急性心肌梗死患者医院感染病原菌分布与耐药性分析[J].检验医学与临床,2013,10(5):573-5.
[7] 谢艳丽,龚立,汪力,等.先天性心脏病合并感染性心内膜炎患儿病原菌培养及其耐药性分析[J].中国病原生物学杂志,2017,12(8):780-2.
[8] Tondo ML,Petrocelli S,Ottado J,et al.The monofuctional catalase KatE of Xanthomonas axonopodis pv.Citri is required for full virulence in citrus plants[J].PLoS One,2010,5(5):e10803.
[9] Rose A.TnABaR1:a novel Tn7-related transposon in Acinetobacter baumannii that contributes to the accumulation and dissemination of large repertoires of resistance genes[J].Bioscince Horizons,2010,3(1):40-8.
[10] 杨彪,何益萍,周妍,等.心内科住院患者合并医院感染的临床特征分析[J].中华医院感染学杂志,2011,21(8):1536-7.
[11] 黄伟丽,孙迎娟.心血管内科患者医院感染控制措施探讨[J].中华医院感染学杂志,2011,21(2):316-7.
[12] 宁丹霞,杨雪英,刘年安,等.326例心血管疾病医院感染分析及对策[J].中华医院感染学杂志,2006,16(2):152-3.
[13] Smani Y,Pachon J.Loss of the OprD homologue protein in Acinetobacter baumannii:impact on carbapenem susceptibility[J].Antimicrob Agents Chemother,2013,57(1):677.
[14] Hanberger H,Walther S,Leone M,et al.Increased mortality associated with methicillin-resistant Staphylococcus aureus(MRSA) infection in the intensive care unit:results from the EPIC II study[J].Int J Antimicrob Agents,2011,38(4):331-5.
[15] 谷倩倩,王斌,赵元平,等.伴多重耐药菌感染的慢性心力衰竭患者病原学特点及影响因素分析[J].中国病原生物学杂志,2018,13(4):413-6,420.
[2] 陈向东,曹淑贞,马军,等.慢性心力衰竭患者并发医院感染的临床分析[J].中华医院感染学杂志,2014,24(17):4269-71.
[3] Rello J,Ollendorf DA,Oster G,et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J].Chest,2002,122(6):2115-21.
[4] Pawar M,Mehta Y,Khurana P,et al.Ventilator-associated pneumonia:Incidence,risk factors,outcome,and microbiology[J].Cardiothorac Vasc Anesth,2003,17(1):22-8.
[5] Chan WH,Khin LW,Chung YF,et al.Randomized controlled trial of standard versus high-dose intravenous omeprazole after endoscopic therapy in high-risk patients with acute pepticulcer bleeding[J].Br J Surg,2011,98(5):640-4.
[6] 周军,李清.急性心肌梗死患者医院感染病原菌分布与耐药性分析[J].检验医学与临床,2013,10(5):573-5.
[7] 谢艳丽,龚立,汪力,等.先天性心脏病合并感染性心内膜炎患儿病原菌培养及其耐药性分析[J].中国病原生物学杂志,2017,12(8):780-2.
[8] Tondo ML,Petrocelli S,Ottado J,et al.The monofuctional catalase KatE of Xanthomonas axonopodis pv.Citri is required for full virulence in citrus plants[J].PLoS One,2010,5(5):e10803.
[9] Rose A.TnABaR1:a novel Tn7-related transposon in Acinetobacter baumannii that contributes to the accumulation and dissemination of large repertoires of resistance genes[J].Bioscince Horizons,2010,3(1):40-8.
[10] 杨彪,何益萍,周妍,等.心内科住院患者合并医院感染的临床特征分析[J].中华医院感染学杂志,2011,21(8):1536-7.
[11] 黄伟丽,孙迎娟.心血管内科患者医院感染控制措施探讨[J].中华医院感染学杂志,2011,21(2):316-7.
[12] 宁丹霞,杨雪英,刘年安,等.326例心血管疾病医院感染分析及对策[J].中华医院感染学杂志,2006,16(2):152-3.
[13] Smani Y,Pachon J.Loss of the OprD homologue protein in Acinetobacter baumannii:impact on carbapenem susceptibility[J].Antimicrob Agents Chemother,2013,57(1):677.
[14] Hanberger H,Walther S,Leone M,et al.Increased mortality associated with methicillin-resistant Staphylococcus aureus(MRSA) infection in the intensive care unit:results from the EPIC II study[J].Int J Antimicrob Agents,2011,38(4):331-5.
[15] 谷倩倩,王斌,赵元平,等.伴多重耐药菌感染的慢性心力衰竭患者病原学特点及影响因素分析[J].中国病原生物学杂志,2018,13(4):413-6,420.
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